Wernicke's Encephalopathy Puns

Hi All,

I quit alcohol on January 1st. I’ve been experiencing withdrawal and issues since. It seems most people get better with time. I haven’t. My biggest concern is my memory seems to be declining. I don’t know where to go to be tested or what to do.

If you've seen it/ Treated it/ had any personal experience involving it, please let me know. After 3 weeks in the ICU, the docs still can't diagnose what's happened to my father. Their closest GUESS, not official diagnosis, is Wernicke's Encephalopathy. They're still confused by him.

He was found wandering down a road, extremely dehydrated and confused. Negative tox screen. Negative for alcohol. No drug use ever. Presenting with extreme confusion (Doesn't know ANYTHING, not even his own birthday or what year it is). Can't speak- when he can speak, it doesn't make any sense. Agitation. Clear CTs. No sign of stroke. Extremely rigid extremities. Constantly dropping magnesium, potassium, & B vitamins. Failed a swallow test and needs to be nutritionally "fed" through a PICC line. Had a major sodium crash down to 118-- Sodium is balanced now at 135...the list goes on. We're 3 weeks in and he appears to be getting worse.

63, Male. 6'1, 180lbs. Prior to hospitalization, no medication. Chronic alcohol abuse over 20 years (several vodka drinks every night). Full prostatectomy 5 years ago for multi-lobal cancer. Mother died from leukemia and father died from Alzheimers.

Please help me. The doctors are calling him "a very complicated and confusing case".

Objective: Pregnancy a normal physiological condition is worsened by morning sickness, nausea and vomiting of pregnancy, hyperemesis gravidarum, Wernicke’s encephalopathy and Korsakoff syndrome in vulnerable women with gestation. This report of three cases described hyperemesis gravidarum, Wernicke’s encephalopathy and Korsakoff syndrome in the worsening pregnancies.

Methods: Prospective collection of data concerning three pregnant patients seen in Dubai Health Care City, Dubai, United Arab Emirates.

Results: All three patients were admitted to the hospital with manifestations of HG and WE and one of them showed additional features of Korsakoff syndrome. One patient developed intractable hyponatremia and central pontine myelinolysis. Two patients developed abortion while one patient's pregnancy ended with successful delivery with living infant. All patients were managed with thiamine, antiemetics, parenteral fluids and electrolytes and one patients required steroid therapy.

Conclusion: The findings of these cases are compatible with international literature on HG and its sequential syndromes. This study may enhance awareness of HG, WE and KS and also fill the knowledge gap of professionals providing services to women with worsening health during pregnancy in Arabian Gulf countries.

Please read full article : - www.journaljammr.com

I created my anki deck a long time ago based from Khan Academy, and I'm not sure why I have it on there.

Female 29 5'4 118 currently taking b1, corlanor, and a multivitamin. Developed wernicke encephalopathy after some complications with the gastric bypass(is reversed now) and it's been about a year from my last scan. Im not sure what to expect with my appointment tomorrow as I only have faint memories of my last appointment. I have blasted through all goals in pt and only have to work on the inner ear and graduated from speech therapy last year so need to know if he will order a new script to continue or if he will discharge. If anyone could help prep me for tomorrow it would be much appreciated as I don't know what is going to happen and I'm secretly crossing my fingers I don't need an

You probably don't have it.

A 34 year old white male, 6'1", was an alcoholic for about ten years. He quit cold turkey 3.5 months ago without any medical guidance or attention. Since quitting drinking he lost about 20-25 pounds and is currently about 245lbs.

About a month ago he started having some confusion and balance issues. He attributed it to not enough sleep, but would sleep from the afternoon to evening for hours, so he was sleeping. An otherwise very intelligent and kind individual, as the weeks go on he is making less and less sense, no longer understanding simple concepts or questions much of the time, and trying to understand him or get him to understand only results in him lashing out. His memory is fading, to completely forgetting a big event that happened 2 weeks ago that he was very much a part of, to forgetting a conversation had an hour ago, to forgetting the topic of a conversation he's currently participating in. Today I believe he had a slight visual "event" or hallucination, he thought he saw a person doing something but it was an inanimate object that one in the right frame of mind would not mistake for a person. Later in the day, I believe he had an auditory hallucination. He heard someone he knew speaking through a radio, there was nothing on the radio at the time remotely similar to what he thought he was hearing.

Could this be either of the aforementioned issues? Would they affect someone who is nearly 4 months sober? I have read that Wernicke's encephalopathy is a medical emergency, but since this has been a deterioration building up over weeks, is it beyond that point and now to a point of damage that can't be undone? Do I send him to the ER or a primary doctor? This feels urgent in that he is getting worse every day, but I don't know if we've surpassed the point of medical emergency.

I hope this isn't an inappropriate post here, as this is not about me. It is not about someone I have any control over, or I would be en route to the hospital now anyway. It is just a friend I am trying to help, and it's difficult with the glaring cognitive issues. I just need to know where to tell him to go and hope he goes. Thank you so much in advance for any consideration.

I can't seem to connect the dots. Can someone help me?

We are taught in medical school that alcoholic patients should receive thiamine (with magnesium) in a few large doses as soon as possible when admitted to prevent Wernicke's Encephalopathy.

I know that thiamine is a cofactor for transketolase, pyruvate dehydrogenase, and alpha–ketoglutarate dehydrogenase. Those enzymes help break down glucose, create acetylcholine, create myelin, and help create the backbone for nucleic acids. In the absence of thiamine, these enzymes decrease in activity, which can lead to cell injury/death due to decreases in ATP/NADPH creation.

I know that in order for thiamine to be useful it needs to be phosphorylated. I read that alcohol can decrease the uptake of thiamine and the conversion of thiamine to thiamine diphosphate.

Why is the absence of alcohol in an alcoholic important for the progression to Wernickes in the hospital setting? Why doesn't Wernickes happen at home? Do we tell alcoholics in outpatient clinics to start increasing your vitamin B1 intake? If it's not the absence of alcohol that is the problem, what are we doing to patients in the hospital vs. at home that makes us concerned for this problem of decreased thiamine?

I'm a 25 year old Male that recently had a psychotic episode last December, they had diagnosed me with severe Bipolar 1 with Psychotic features but also a possible Wernicke's Encephalopathy diagnosis.

My psychotic symptoms are almost all gone except for delusions I'm able to pick apart (I have full insight, now). However, I've been having a strange feeling in my head.. Inflammation it feels like, nearly everyday for months now.

Could this have anything to do with the possibly Encephalopathy diagnosis? I was referred to a neurologist for an MRI, I'm wondering what I can do now to reduce the burning feeling in my head 24/7 for the time being. Are there any supplements or over the counter medications that are safe to take that would give me relief?

Hi so as a background, I’m a 30yo white female with a history of eating disorder (13 years anorexia/bulimia) and alcoholism (2 yrs - 2 bottles wine to 1/5th vodka 4-6 days/wk). Was diagnosed with low thiamine last time I was in treatment for ED (2019) but probably had it prior to that as well. 3 weeks ago started having severe cognitive/memory issues as well as neurological issues. I had heard of wet brain but thought it only affected memory and that there was no way I could have it as I hadn’t been drinking long enough (didn’t know it could be caused by eating disorders as well).

Anyways…finally went to the ER Sunday after someone said I was slurring my words. Everything came back normal accept low thiamine. Was put on oral supplements (500mg).

Nothing has improved and today I’m falling over. Thinking of going back to the ER and straight up telling them I think I have Wernicke’s Encephalopathy, and ask for B1 injections. How appropriate is this? I’m afraid they’ll not take me seriously/think I’m overreacting/self-diagnosed on google. In fact I did google the symptoms but was not expecting to see literally every over symptom I was experiencing along with the amnesia and confusion: dizziness, blurry vision, apathy, extreme fatigue, muscle coordination problems, and sudden onset of symptoms.

Everything I’ve read online says it’s a medical emergency that needs to be treated with aggressive B1 supplementation in a hospital setting. Obviously I don’t know as much as a dr but don’t want to take a chance on permanent brain damage. Thanks.

Why YSK: It takes extra thiamine and folic acid to process alcohol, leading to deficiency if the individual does not supplement. Thiamine deficiency can progress to Wernicke’s encephalopathy or Wernicke-Korsakoff syndrome (WKS) which can be deadly and requires medical treatment. The treatment is thiamine supplementation. If left untreated it can lead to death or cause permanent neurological damage.

https://www.ncbi.nlm.nih.gov/books/NBK470344/#article-31338_s2

Edit: previous post deleted due to no citation

Hi all I get the title seems misleading and nearly impossible but please hear me out I think I have developed this shite. So I'm 19 years old, 6'4, 92kg. And I've been drinking since 2016 so year 10 not heavily but I first used it then more than once. Off the top of my head I got drunk in 2017 about 40 or so times and in 2018 around 45 or more times and 2019 probably about 45-50 times and last year even more. 2020 was probably my worst year as I began using alcohol very heavily often drinking bottle of wine and beers or 2x wine bag per day at my worst so 2-3L. I used alcohol heavily on and off throught the year and drunk for a month straight every day. I made conscious efforts to quit and did for weeks at time then drinking again, I did not face DT's or anything serious like that. Then around November 2020 I lost weight and started having neuropathy in my lower half whilst sitting on the toilet and felt this slight wierd brainfog sensation. Then I got in a car accident on December 15th and refrained from alcohol for a while. Note: throught this year I did eat a healthy balanced diet alot of the time and took vitamin C, magnesium powder daily.

Then on January 18th 2021 I hadn't been eating or sleeping very well and had consumed 2x bottles of 1L bacardi over a 3-day period prior then at around 1AM on January 18th I woke up from a severe nightmare drenched in sweat with derealization, chills, memory loss, vertigo and I threw up and had diahorrea then the next morning all symptoms went away and I felt sort of off but I refrained from alcohol for the next 3 weeks.

Then on February 4th I went on holiday and suffered vertigo on the car ride down. Then on February 6-7th I drunk 2x bottles of wine and some beers and was fine for the next couple days until February 8th when I came down with the flu. The flu lasted for a few days until February 10th when I got home the morning of February 10th I woke up with derealization, severe brainfog, short-term memory loss, sleep disturbances including: hypnogogic hallucination and hypnic jerk, paranoia and couldn't recognise my family or friends and everything seemed frightening, I also had diahorrea, Gut issues like fatty stool and also developed visual snow and slightly blurry vision. I went to the ER Feb 12th and mentioned my past alcohol use but no action was taken. These symptoms continued for 4 months and I started having mini-stroke like attacks during one of these attacks I went to The ER and got a CT scan w/o contr

20 days sober for my Dad. This is the 2nd time he's gone through medically supervised detoxing. Ended up having Wernick's Encephalopathy and was extremely malnourished before he went into the ICU. His brain was literally changing.

He's healing, and every day that goes by he gets more of his personality back. My husband has seen me get my hopes up before only to have them dashed, so naturally he's hesitant. We consider every day a win. I have a one year old daughter, and would love for her to have a relationship with her grandfather. At this point in time, any positive memories we make are more than I thought I would get. Will update on here when we get to 30 days. Hang in there everyone out there who has a parent that looks like they're too far gone- you never know.

I met with my prospective surgeon about a sleeve procedure this past week. When I asked her about the health consequences of WLS and I found her answer to be too focused on the 30 day post-surgery mortality rate. What about the long term?

We all learn about bariatric surgery and the increased risk of Wernicke encephalopathy and B12 deficiency induced encephalopathy without supplementation. I am more concerned about the neurological effects of the decrease in ghrelin. Isn't ghrelin important for the regulation of dopamine? Sure, brain hunger isn't great, but normal- to elevated- levels of ghrelin ain't all bad:

"In addition to ghrelin’s role in glucose and energy homeostasis, research over the last 15 years has revealed a surprising variety of additional physiological functions of ghrelin in areas as distinct as learning and memory, psychological stress, mood and anxiety, depression, thymopoiesis, sleep/wake rhythm, and aging. Recent pharmacological intervention trials also point to a neuroprotective role of ghrelin in neurodegenerative diseases (e.g., Parkinson’s disease)."

This paper even hypothesizes that the reason obesity predisposes people to Parkinson's, for instance, is because people running a calorie surplus tend to have less ghrelin in their system. Post-WLS individuals will lose weight, but will also make even less ghrelin.

My surgeon is not an endocrinologist, nor a neurologist -- I'm not sure how reasonable it is for me to try to ask her to address this worry. Has anyone's education program flagged this? Maybe someone on here who also sees an endo or a neurologist has discussed the long term consequences of the ghrelin drop?

This is a short review of the film. Hirokazu Kore-eda has also made narrative feature films such as Shoplifters, Nobody Knows, Our Little Sister and After Life. If you don't want to read a review and just want to watch the film, you can click here to do so.

Review

Without Memory is a made-for-TV documentary about a man in Japan named Hiroshi who, after medical mistreatment following surgery, has developed Wernicke’s Encephalopathy, a memory disorder. He still remembers himself, his family, friends and life in the time before the operation, but finds it almost impossible to retain new memories, forgetting everything mere hours after it happens.

Every day, he wakes up confused and anxious, and unsure why. Every day he re-learns the details of the condition that afflicts him. The film follows his daily life, talks to him about his thoughts on his condition, and documents his interactions with his family.

I found Without Memory to be incredibly emotionally affecting. Hiroshi seems like a very pleasant, intelligent and articulate man, gripped by anxiety and confusion about something he cannot properly comprehend. Because he forgets, he has to learn of his condition anew every day, making it impossible for him to be able to accept what is happening to him, build on it and move forward.

He keeps a diary and constantly leaves himself notes. Photos and video are taken constantly, so that Hiroshi can document his life and look back over it with his wife, Miwa. However, none of this works in the way it normally would, the notes and photographs have no context for Hiroshi. Usually, when we look at a note or a photograph we will remember the context in which it was written or the time that it was taken, but for Hiroshi this does not happen.

Sometimes, he will recall a particular emotion associated with a given photograph or when speaking with his wife about something they had done in the recent past, but often Hiroshi recalls no image at all. On one occasion he visits the supermarket with his son, Taku. Taku carries the basket as it gets filled with fruit, chosen to meet the needs of a shopping list Hiroshi clutches in his hand as they walk around the store. Taku complains that the basket is too heavy, so Hiroshi takes it from him. The pair then take a fair bit of time looking for dried seaweed, and when they find it Hiroshi spends quite a while in consideration about which type he should buy.

After arriving hom

Do your worst!

Has thiamine supplementation helped anyone with Covid at any stage? Has it been discussed or recommended? Interested in personal experience or research.

Possibly better choices might be benfotiamine or sulbutiamine, versus thiamine, due to significantly higher absorption. Deficiency of thiamine in pre or post Covid exposure suggests benefits of supplementing to improve health outcome parameters.

Also note: If there is an injury to the olfactory bulb due to trauma, infection, or allergies, this can lead to problems with your smell. The best nutrients to support the olfactory bulb are:
• Zinc
• Vitamin B1 (benfotiamine)
• Alpha-lipoic acid

I have noted better smell since adding benfotiamine, which loss of smell initially occurred in February or approximately 6 months ago. I am doing the above protocol for smell.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242279/ Thiamine also works as a carbonic anhydrase isoenzyme inhibitor; thus, high doses of thiamine given to patients at the early stages of COVID-19 could limit hypoxia and decrease hospitalization.

https://pubmed.ncbi.nlm.nih.gov/32869036/Thiamine, a very safe drug even at very high doses, could be repurposed for treating the cytokine/immune storm of COVID-19 and the subsequent neurological symptoms observed in COVID-19 patients. Further studies using thiamine as an interventional/prevention strategy in severe COVID-19 patients could identify its precise anti-inflammatory role.

Encephalopathy responsive to thiamine in severe COVID-19 ...

https://pubmed.ncbi.nlm.nih.gov/33817670/Encephalopathy is one of the most frequent neurological complications of severe Coronavirus Disease 2019 (COVID-19) patients. Cytokine storm and sepsis, hypercatabolic states, the use of furosemide and dialytic therapy represent risk factors for thiamine deficiency and are also found in patients with severe COVID-19.

Wernicke Encephalopathy in COVID-19 Patients: Report of ...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952637/ Abstract Encephalopathy has been frequently reported in patients with acute respiratory distress syndrome (ARDS) rela

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies 😂

It really does, I swear!

They’re on standbi

Pilot on me!!

The scenario:
It's Friday evening, and you are 20 minutes from your off time on a standby at the local college's LARPing festival. As you sit contemplating the cold beers in your fridge at home, dispatch kindly lets you know there is a dialysis return waiting for you on the other side of the county when you clear. Great. As you contemplate calling out of service for "mechanical problems", you're startled by a heavyset campus cop squeezed into a Lycra bike patrol uniform knocking on your window. "Hey, there's this drunk guy here. Can you check him out?" "Dispatch," you call into the radio, "we can't take that return, we have a patient." Maybe this will get you home faster.

The patient:
The officer directs you to an apparently homeless man with a shopping cart full of bags. "This guy is a regular around here. I don't think I've ever seen him sober. Normally, we just ignore him, but he is bothering students and I saw your ambulance here." The patient's name is George, and he looks to be in his 40s. You see his shopping cart is filled with trash bags and empty liquor bottles. You start to interview the patient. "Hello sir, how's it going?" "Go... go fuck your nose. You stole my... spatula!"

After sizing things up, determining the scene is safe, and putting on your BSI (poorly fitting gloves and safety squints), you conduct an assessment as follows:

Vitals: HR 86, BP 134/82, RR 20, SpO2 98% on RA
General: Disheveled and poor hygiene. Agitated, but not aggressive.
HEENT: Atraumatic. PERRL, but sluggish. Lateral gaze nystagmus. Sclerae anicteric. Moist mucous membranes. Several teeth in varying states of decay. No smell of alcohol or ketones. No JVD, trachea midline.
CV: Cap refill <2s. RRR. S1 and split S2. Radials 2+.
Resp: Airway patent. B/l chest rise, lungs clear in all fields. Breathing unlabored.
Abdomen: Soft, non-tender, non-distended. Liver palpable 6cm below costal margin. No splenomegaly.
Ext: Strength 5/5, ROM seems wnl, but exam is limited by lack of cooperation. Abrasion to left hand and forearm with some capillary bleeding controlled with dressing.
Neuro: A&O x 1/4 only to self. Pt has difficult time coming up with words. He seems unaware of the abrasion to his arm or how he got it. Pt is grossly ataxic and walks with unsteady, wide based gait. Not cooperative for sensory exam. Cincinnati stoke scale negative.

Labs: Blood glucose 54 mg/dL

Your resources:

• You are 1

Dad jokes are supposed to be jokes you can tell a kid and they will understand it and find it funny.

This sub is mostly just NSFW puns now.

If it needs a NSFW tag it's not a dad joke. There should just be a NSFW puns subreddit for that.

Edit* I'm not replying any longer and turning off notifications but to all those that say "no one cares", there sure are a lot of you arguing about it. Maybe I'm wrong but you people don't need to be rude about it. If you really don't care, don't comment.

What did 0 say to 8 ?

" Nice Belt "

So What did 3 say to 8 ?

" Hey, you two stop making out "

When I got home, they were still there.

I won't be doing that today!

You take away their little brooms

This morning, my 4 year old daughter.

Daughter: I'm hungry

Me: nerves building, smile widening

Me: Hi hungry, I'm dad.

She had no idea what was going on but I finally did it.

Thank you all for listening.

There hasn't been a post all year!