Onset Puns

I have seen this on Twitter and was wondering if it was true?

Chief Complaint: “She has been short of breath and not has a bowel movement in 15 days”.

HPI: The patient experienced a fall 2 weeks prior from the current event, causing a humerus fracture. She was transported to the ER and underwent surgical repair of the fracture, spent 1 week in the hospital and was discharged home. She had a medical history of atrial fibrillation, anxiety, and hypercholesterolemia. Over the previous few days from this EMS encounter, the patient and family reported intermittent periods of shortness of breath. At the time of the 911 call, the patient was in moderate distress and tachypneic, and stated “it’s just too bad and I can’t catch my breath”.

Assessment: On assessment she was conscious, alert, oriented, sitting reclined supine in an easy chair. Her respirations were tachypneic and shallow with evidence of discomfort on inspiration. Physical exam is noted below. The patient denied paroxysmal nocturnal dyspnea, orthopnea, and denied taking anticoagulants since her hospital discharge, which was instructed by the discharging physician. She was notably anxious, and extremely hesitant to be readmitted to the hospital. The family also reported the patient had not had a bowel movement in over 15 days. Her abdomen was noticeably enlarged with a slight fluid wave present.

Physical Exam:

• Respiratory Rate: 22-26, shallow and appearing painful on inspiration
• Initial O2 saturation: 94-95% on room air; 99% on 2 LPM nasal cannula
• Pulse: 84-94
• BP: 109/63, 114/41, 128/68
• Lung sounds: rales at posterior bases, apices and medial aspects were clear to auscultation bilaterally
• Height: 5’ 7”
• Weight 267 lbs
• Blood glucose: 322 mg/dL
• Skin: pink warm, and dry with evidence of bruising from the prior fall
• Temperature: 98.4 F
• Pupils: PERRLA
• Eyes: unremarkable
• Head: no evidence of lacerations, bruises, or hematomas anywhere with no nucchal rigidity
• Abdomen: soft, non-tender, distended and enlarged, slight fluid wave, with no evidence of wincing, guarding, or vocalization of pain when palpated. No rebound tenderness, no pain to percussion, and evidence of bruising from prior fall along the right flank
• Extremities: 2+ pitting edema through the knee which family reported was new onset, all pulses present at 2+; No Babinski (extensor plantar) reflex present. Severe bruising on the right arm from the previous fall.
• Medications
  • Eliquis (apixaban) – discontinued at time of surgery, not restarted
  • Oxycodone

There are plenty of reasons to believe we are at or near the top of a bubble. When wall of kelp and river Merfolk pump, something is amiss, and dumb money is officially in the game.

It’s no secret that an obscene amount of fiat money has been printed around the world in an attempt by central banks to prevent economic collapse. The consumer-price index, a tool often used by government entities to deceive the public into believing we aren’t actual seeing inflation, is a joke and a lie. ANYONE leading a family life during this climate can tell you that inflation is REAL and it is nowhere near the 1-2 percent the FED is claiming. So, how do we protect ourselves, our capital, and our investments?

One way to do so is to stay out of cash and invest into commodities, collectibles, and precious metals. Or at least, most people think so. Personally, I’m using magic the gathering cards as one of my vehicles to hedge against the risk of inflation. However, it feels like we are at or near the top of a collectibles bubble, and as if we are in a seller’s market. That is one of the points of inflection for discussion that I’m curious to see how others feel. Hopefully, doing so without being super toxic.

Are magic cards a good vehicle to hedge against inflation? Do you think inflation is a huge risk? Do you think the OPPOSITE can happen, and there may be a sell off because of market collapse, and money goes into bonds due to the FED being forced to finally raise interest rates, and as a result, magic cards fall in price because those in financial distress have to liquidate their assets? I certainly hope this can be appreciated as a worthy topic for magic finance. I’d like to get a feel for sentiment.

Or The A.P.E. Party for short! I am so tired of seeing how out of touch and blatantly corrupt our(American) gov't is. I know it's been like this forever but then again us little guys have been kept pushed down in the mud forever. We have a chance to start something really special after the MOASS. I've seen the posts. We are caring and have empathy and most importantly we'll have each other and a shit ton of money. It's obvious that's what it takes. When this is over I for one will be the change I seek and run for office. If I end up not doing that I'll at least try to buy someone. That seems like it would be easier. 😂😭. Anyways be good to each other and remember.....don't be so hard on yourself. The only reason you are reading this is cause your dad didn't pull out of your mom. You only need to do 2 things in life. Be a good person based on your own morality and live YOUR own life regardless of what people think. If you can do them both at the same time, you win. Everything else is just your own video game. Power to the Players. 💎 ✋ 🐵 🚀 🌙

TLDR: Americans for Prosperity and Enlightenment Party or the A.P.E. Party for short. I want your thoughts on it.

Edit: Ask me what my policy on anything would be if you are interested. Any thoughtful discussion would be great.

I am not claiming that he did a splendid job like Pinari Vijayan and all. But helming a state which is the worst affected in our country , he did managed well. Even BMC was bashed unnecessarily without understanding that social distancing in half of Mumbai which lives in slums is a luxury.

Starting local trains was inevitable, as it is the lifeline and when cases were dropping there was lot of pressure from working class to resume services. Later on the same became the super spreader.

But despite having the maximum cases, the situation is not as horrible as in Delhi and UP , and even the model state gujrat. I am still not able to fathom that how Gujrat which is at par in terms of industrial with maharastra, is facing scarcity of oxygen.

People are not dying left, right , center due to lack of oxygen , there are mismanagements happening in many hospitals ,but cluster fuck at top level is atleast not seen . Do remember that dying due to covid and dying due to lack of oxygen are two different things. I know many people who got covid treatment totoal free of cost at jumbo covid centres .

People bashed him stating he has no administrative experience, without realising that atleast he consult experts when making decisions unlike bisht and gobhi jee where their PR overrides every other authority in administration.

So I did a quiz called Tinnitus Handicap Inventory, a quiz that is often used at tinnitus studies when they give it to the person before experiment and after and then compare the results and give a conclusion whether the experimental treatment works or not.

It is said that 16/100 is the border when your tinnitus is starting to be noticeable. Therefore going below 16 points is basically habituation. However, I am now at 80. Will I ever go down?

Is anyone who has take the vaccine experienced late onset of side effects weeks after injection. Specifically numbness, pain, tingling in fingers and toes and upper left abdominal pain? I received the J&J and would like to hear from others experiencing what I am. For those in the same boat, I pray that you find relief soon.

For some context I am a healthy mid 20s male with no history of hearing issues.

I had covid-19 in March 2020 with mild/medium symptoms, no long term impact.

I took the Moderna vaccine on April 14th, had a really rough few days (basically the same as my covid with slightly less fever but significantly more brain fog).

All that has mostly passed but I have had persistent ringing in my left ear (my shot was in my left arm - though that doesn't seem like it would be related).

It's very light, but if a room is silent I definitely hear a low drone (think like a metal fan rotating). I have confirmed by moving around rooms, sound canceling headphones, stepping outside. I also continue to feel like my head isn't completely normal.

The only related discussion I've found is here: https://www.drugdiscoverytrends.com/tinnitus-reports-grow-amid-covid-19-vaccinations/

Let me be clear - I am not an anti-vaxxer, I'm well versed in biology (and have a BS in genetics). I am familiar with how mRNA is delivered via lipid nanoparticles so that our cell's ribosomes build the covid-19 spike protein. I know the mRNA degrades overtime and the built spike protein is assumed harmless.

However, I am now less convinced we are certain about the impacts of the strong immune response itself. I suspect an overly vigorous immune response is damaging in of itself (think auto-immune diseases). My health provider acknowledge tinitus as a known side effect and said the current working theory is its caused "oxidative stress" induced nerve damage.

I am fairly frustrated that I have a potentially life long side effect for a vaccine I very likely did not need (age, prior covid, good health) & worried that decision makers aren't seriously discussing these potential tradeoffs in a understandable attempt to avoid fueling the anti-science fire.

EDIT: Fascinating to see the up/down vote war going on - if you feel the need to downvote, please feel free to comment, I'm happy to answer any questions / can understand the knee jerk reaction against what may sound like hyperbolic fears.

I have a 50 yo F with PMH of well-controlled hypothyroidism and iron deficiency anemia who recently recovered from COVID 19. She recently presented to our ED with a serum glucose in the 700s without history of DM. FBGs have been in the high 300s to 400s. So far, workup for LADA has been negative. Started on Metformin-Glyburide, however, FBGs remain high. Has anyone else had any post-COVID patients develop new-onset DM?

I’m in my 7th month of tinnitus and muffled hearing.

What do you wish you knew within a year of the onset? Is there any help or treatment you would have tried?

No, the greatest disaster was what became of society when only the most proudly ignorant people were left behind to rebuild.

I’ll keep up on the trip report (which will be in the comments of this post) for as long as I can until I blackout. My highest dose up to this point was 1.75g, which was uneventful. But I don’t work or have class tomorrow or the next day, so I’m ready to spend the next 24-48 hours in a state.

I just ate a decent sized meal so the come up is probably gonna be a while, but last night (1.8g) even after eating it only took like 45 minutes to kick in. It usually takes about 2ish hours or so, which is what I’m expecting tonight.

Also before you lecture me, yes I am stupid and yes I have a slight death wish. Death by DPH is too painful for me to want it to happen though, so I wouldn’t be taking this dose if I thought it would kill me. Keep in mind, I’m a pretty large person (6’3” 240lbs) and my tolerance is ridiculously high, so taking 2g is probably okay (don’t quote me on that).

BUT, if I do wake up in a hospital room tomorrow, I’ll send $25 to whoever puts a not-mean comment on here. If I die tonight, the nicest person in the comments gets to write my eulogy.

Also there’s a secret treasure map in my apartment that leads to where my endless wealth (mountains of gold, piles of diamonds, a few Bugatti’s) is located, which belongs to whoever finds it first if I die.

She gave away $1000 via zelle to someone claiming to be from eversource and they were going to shut off their power.

In the last 7 months I have developed sudden onset eczema on both my hands and forearms half way to the elbow. No changes in diet, skin products, cleaning etc. nothing makes it go all the way away. It can be a 2 one day and a 7 the next. Some patches have stayed for months. I got a rx cream that helps for big flares. It seems so out-of-the-blue to get it in my late 30s....is this common? Thanks!

I fit the criteria for hEDS/HSD (Beighton score, stretchy skin in certain areas, wound healing issues, easy bruising, autonomic dysfunction [heart palpitations, brain fog, etc.], constant throwing of lower back / tearing of connectors in mid back, etc.).

The thing is, I had an abrupt onset about 4-5 years ago. Before that I was perfectly healthy. No stretchy skin, only nagging injuries were ankle sprains but once I added some muscle those went away, no brain fog or anything. Strong and athletic.

And the symptoms came on gradually, it wasn't all at once. (first muscle degradation, then issues with individual joints, then brain fog, then full-blown skin problems and connective tissue problems).

Is this permitted by the framework of a hEDS diagnosis? I've heard differing answers from doctors on this.

Wondering what your experience is.

They will probably reach one million at May 4th and 5th respectively, according to current view rates. However, due to the intrinsic random fluctuations of these figures, any could get there first. If I am not mistaken, it is the first time two B-M YT videos get to one million that close of each other.

Niantic suddenly announced that the the switch clock will be reduced to 30 seconds in GBL from March 31st, 4 AM (PT) until April 5th, 2 PM (PT). This is such a massive change to one of the most fundamental mechanisms of pvp that we can expect to see some radical changes in how people play and strategize in GBL:

1. Switch advantage will generally be less important since you can only be switch locked for at most 30 seconds and most matchups will last longer than that, meaning you can just stall and try to realign via switching.
2. Sac swaps will be very common and very important. 4-minute battles with 30 second switch clocks means that theoretically each side can pull off 8 or more switches in a game for a total of 16+. That is a lot of opportunities for sac swaps. The "will they won't they" mind game of shielding will also happen a lot surrounding switching.
3. More sac swaps also means that it's easier to create switch clock mis-alignment: if you catch opponent's charged move on a different mon, that mini-game/animation will take almost 10 seconds meaning that your switch clock is now 10 seconds ahead of your opponent and even if they then switch to a counter, they only have less then 20 seconds and if you can basically just get out of that bad matchup just by throwing a move, and potentially catching their charged move again when you switch, and so on.
4. Self-debuffing moves will be more popular because the penalty to switching is less severe now.
5. Similarly, self-buffing and opponent-debuffing moves will be less useful since your opponent can just switch out more easily.
6. There will be more aggressive switch-ins to either surprise farm down or use a charged move or get an energy advantage, etc.
7. Spammy moves are more desirable since often it will be more beneficial to spam and stall out the clock then to use a nuke and hope to get a shield or KO.
8. Fast move syncing will be a mess since switches tend to create minor desyncs. Preventing free fast moves will be even harder.
9. Counting moves will be a lot harder since now it’s easier to lose track of how much energy each of the opponent mons has after multiple switches.
10. Slow fast moves may become less desirable since opponents are more likely switch during your animation and farm you down/use a charge move before you can do anything.
11. GBL matc

So. In the past year I’ve experienced sleep paralysis a few times around 6-7 instances. But today I experienced a sleep paralysis or either an onset of schizophrenia .. (I hope not) I’d really like to hear your opinions.

So last night I had went to sleep at around 2am waking up 8am. Not great hours.... but felt like a solid sleep. Surprisingly I felt well rested and ready to go. I went for a drive got some cigarettes.. had breakfast.

Now It was around 1pm I started to feel a little tired and decided I should get some sleep before my 10pm shift. I got into bed and this is where the story begins.

I closed my eyes and was getting settled into what I thought was going to be a peaceful nap. It took me around 30 minutes of shut eye.. and I started seeing mediocre colour blurs and thought nothing of it.. the blurs were a purple slowly but naturally changing turning a dark dark blue then turning a dark dark black. I then fell asleep.

I woke up to the song juice wrld ‘wishing well’ playing in my head instrumental and all- in sleep paralysis. This had never happened so I thought it was playing off my phone. But the only lyrics played were the very start of the song where he sings “NINE , NINE , NINE”. After he said this the instrumental stopped and I realised it was in my head. But my brain tried to play the instrumental afterwards and I got heavy shockwaves from head to toe after doing so. ( I was still paralysed at this point ) .

After breaking free I thought that has never happened but that was obviously my dose of sleep paralysis for the next 6 months.

I rolled over and about 10 minutes in I couldn’t sleep and every time I was about to fall back to sleep I was hearing full on dialogue.

When it was apparent I was paralysed every time .

The dialogue was similar to a twitch streamer talking to his viewers or my brother yelling from the hallway. in addition to this I heard babies laughing and a person talking about me in some other language but I knew it was about me. This was off and on ..but during dialogue I was paralysed .

After this I fell asleep but woke up paralysed again to the song MIA paper planes playing in my head instrumental and all.. after a few lyrics were said the instrumental ended and I got massive shock waves from head to toe again.

This was honestly terrifying but I was so tired I tried sleep one last time. But this is when shit was twisted .

I had a dream that I was in McDonald’s and this girl in a white dress with blue coll

My husband and I separated in June of 2020 because at the age of 33, I experienced my first manic/psychotic episode with strong delusions and complete detachment from reality (including emotional detachment from pets and people). I had delusions of grandeur and felt I was in love with a celebrity I had never met before and at the beginning of the episode, I believed the celebrity felt the same about me. I have since been diagnosed with Bipolar Disorder. I was the one that asked for the separation and moved out. I wanted nothing to do with him because I was emotionally detached and too far into believing my delusions. He filed for divorce shortly thereafter. Although he filed for divorce, he started to realize what was going on and did everything he could to get me help from involving my family to speaking to an attorney and discussing an intervention. He was there every step of the way desperately trying to help but I wouldn't let him. But it was just because I was delusional, had no insight into my condition and was also paranoid and thought he was trying to control me because "I didn't need help"

My husband got a puppy during this 5 month separation which I told him I did not think was a good idea but that he could obviously do whatever he wanted. The dog is the same breed (pit/lab mix) and looks almost exactly like the adult dog I adopted in 2004 when I was 19. She just passed in 2019 at the age of 15. My husband and I met in 2012 so he spent 7 years with her. Because she looks like my deceased dog, she also triggers a lot of grief for me.

I began to come out of my episode in November and by December my husband and I were living together again. We have been living together for about 5 months now. We do not have children.

Coming out of this episode with a high energy puppy has been a miserable nightmare. I was not prepared to have a dog for a long time anyway let alone with all of this. I also have new onset OCD tendencies and my anxiety is at an all time high. I have never experienced anything like this before. My husband has witnessed me for months in major distress over the dog as she started getting bigger (50 lbs now), crying and completely emotionally unstable when she would jump and bite at me. I cannot handle the high energy or responsibility of a dog in my life right now. I don't even feel comfortable in my home or like I can relax at all. I was a huge animal lover before my episode and I know he keeps hoping that returns but I don't see it

I received both injections of the Pfizer vaccine in standard sequence. Several days after the first injection (right arm) I noticed ringing in my left ear. This persisted and I received the second dose (left arm) and developed ringing in my right ear.

I have been fully vaccinated for nearly a month and the ringing has not gone away. Luckily it is quite mild and I don’t notice it much unless I’m in a very quite room.

Has anyone experience Covid/ Covid vaccine related tinnitus and has it gotten better/ worse?

Also, very new here so if this has been discussed elsewhere please direct me there and accept my apologies.

I will see an ENT soon. I will try the lipoflavinoids and the ketogenic diet to attempt to resolve this.

EDIT - Update - 4/14/21

I have since seen an audiologist and an ENT. My hearing is normal and I was given the standard tinnitus talk. I pushed for a course of oral anti inflammatory medication; however, that was turned down.

Now for the good news - my tinnitus has gotten better but not completely resolved.

I am unsure why it has gotten better. Maybe I am getting used to it, maybe I am healing as I normally would, or maybe something else.

The something else may include the lifestyle/ diet/ supplements I take/ engage in.

So, for what it is worth here it is:

I bike to work everyday (~10 miles, ~ 50 mins/ day). I lift weights 4x/ week. I pray daily (one could meditate, but it seems like a crappy second compared to communing with Christ). I am in and out of ketosis, but always stay low carb. I take Zyrtec, zinc, lipoflavonoids, curcumin (tumeric), resveratrol, magnesium, vitamin D (only when I am not getting sun) and some prescribed anti-hypertensive medication.

GOOD NEWS THOUGH, the vaccine related tinnitus is better but not gone (yet!?),

TL;DR I think I am behind the curve of mental aging and maturity.

Im 32. I feel like I stopped aging mentally in tandem with the onset of my severe symptoms. I began experiencing mania and psychosis around 19 years old and everyone I meet or talk to thinks I act 19 or 20. I FEEL 20ish. Im in good shape, I look young but its really how I still identify with teenagers and kids in their 20s and relate to them like a peer. I feel like an outsider with people my age (early 30s) and an outsider with people my mental age because I'm a fully grown man. I have some friends in my neighborhood in high school who i hang out with a lot, and they said it was weird at first til they realized im cool and they like me. But I'm so behind ppl my age in a lot of ways. I'm risky with money, wild and physical, laugh all the time and play fight with my friends. My main maturity has been establishing a very grounded and zen mentality and controlling my mood as much as possible before it gets out of hand. I never argue or fight with people for real, i can diffuse fights and make friends with almost anyone. But as far as acting or feeling my age, I spent age 19-28 psychotic and manic depressed almost the whole time and dont really even remember age 22-28. So I'm 32 and am constantly mistaken for being fresh out of high school. I dont feel 32. I dont look 32. It's like everyone left me behind and kept going and I woke up from a nightmare filled cryogenesis as a caveman in the future with flying cars. The only thing I've improved is how I relate to reality - like social skills for example. I still have little emotional connection to reality but I use it as a tool to maintain the zen. My emotions are totally unrelated to actual events and more based on whether my brain decides to be manic or depressed. I also have innappropriate reactions to things like laughing if someone gets hurt or being unable to cry at funerals even if I try to do it just to relate and fit in. My emotions are often inappropriate for the situation. I like to be social because it grounds me in reality but I'm having trouble trying to categorize myself and others. I look at everyone from children and elderly as my peers but I, and this has always been a problem, have no idea what people see me as. I try not to overthink it and I want to amass a giant network of friends now because I've been a loner my entire life and thats not working for me anymore. I just wish people my age, peers, didnt see me as some kind of r

Hello! I was just diagnosed with erythromelalgia, first by a dermatologist and then confirmed by a rheumatologist. I'm wondering if anyone's erythromelalgia was also accompanied by other nervous system weirdness. I have textbook erythromelalgia flare-ups on my feet, hands and face/ears, but I'm also having numbness and tingling in hands, feet and face, weird sensations like cold patches or feeling like something is touching me and lots of random muscle twitches. I do have an appointment with a neurologist, but it's not for a few months.

My doctors have tested me for autoimmune diseases (lupus, RA and Sjogren's run in my family) and checked my blood counts and B12 level -- all normal. I do have hypothyroidism, but it's stable with medication and I have mild Raynaud's.

Just curious if others have experienced the onset of other nervous system stuff along with their erythromelalgia symptoms. Thanks!

Hi fabulous folks,

I’ve taken a lot of advice from this sub and I’m hoping someone might have a recommendation. I’m 42F, generally been good about sunscreen. I was using an OTC retinol for a long time but switched to tretinoin about six months ago. My routine:

Am: cerave face wash, then vitamin C ferulic serum followed by Perricone cold plasma plus. Then Elta sunscreen. Pm: Cerave face wash, then 0.05% tretinoin then a night moisturizer.

Twice a week I use these Dr. Dennis Gross Alpha beta peel packets and maybe once a week I do a glytone mini-peel. I do Fraxel resurfacing and IPL once a year and occasionally I’ll do microneedling.

I really liked my skin! A few weeks ago though I started using power to take away the shine that’s left by my morning routine. It may or may not be related to the fact maybe two weeks ago I just got LEATHERY. When I smiled these tiny lines form all over my skin- not just crows feet. Maybe it is normal aging? I can’t seem to get a good picture- my skin is suddenly so textured.

Has anyone experienced this? Trying to find the balance between doing what I can without obsessing over the inevitable- essentially the Serenity Prayer of skin care.

Thanks in advance!