>>682708991 if you have it exposed, super easy. pic related if you are just pressing on your neck, pretty tough. accidentally? nope. completely blocked: if acute, devastating stroke; if slowly develops, may be asymptomatic if you have adequate collateral circulation
>>682710414 impossible. google 'carotid massage' if you are worried, use your opposite hand (right hand feels left pulse): if you compromise blood flow to the left hemisphere, the right body will go weak and the offending hand will drop.
>>682710609 that's like my favorite question, anon. i learned about that concern when i was preparing for my boards. before that, i had no clue it was on peoples' radar. my opinion, and obv i'm biased, is that pineal gland calcification is of no concern. you routinely see it on CTs. there is no correlation to fluoride exposure in the medical literature. that being said, people will claim it is bad with the same vehemence as antivaxxers. we get exposed to so much shit (presuming you are 1st/2nd world anon) that we don't even know what kind of damage we're doing.
>>682711198 What's that supposed to mean? What substances should I be looking for to 'decalcify' just incase? I know that either way I more or less won't feel or think any differently but subconciously it will make me feel better. Am in canada so water here is pretty legit
>>682711504 my question for you is this: what is your concern? why do you worry about pineal calcification? why do you want to undo this? my point is that 'pineal calcification' is not anything to worry about. it's voodoo.
>>682711747 well I've been meditating and clearing my head out of problems a lot in the recent years. however approx 3 weeks ago my brain all of a sudden feels slower or not as clear, its hard to explain. But I feel a lack of 8hr+sleep per day is to blame, or my excessive drinking of flouride added water (i legit drink a shitton of water every day, sometimes 1-3 ppm)
lets say a patient strokes and you begin cpr. You tell your friends to massage all of his or her muscles to help increase venous return. Is it possible to decrease the rate at which neurons will start to die?
>>682707906 I had a CAT scan about six months ago (it's a long story) Anyway, the doctor said that my brain looked normal. How can this be? I'm a fucked up, alcoholic, semi-autistic weirdo. How the hell did he not find SOMETHING wrong?
also, if you hadn't seen this video yet..a homeless man appears to have a large hole in his head where maggots are eating at his brain. Could you describe what he might be experiencing psychologically?
>>682713289 muscle massage to increase venous return? never heard of that, anon. wasn't covered in ACLS, etc. where did you pick up that trick? as far as rate of neuron death, the important question is what neurons are dead (or at risk of death). you can find some Time=Brain images that work in powerpoint but simply quantification is not clinically relevant.
>>682713837 the picture is not the be-all end-all you can be all kinda fucked but the picture looks fine. the picture can also look fcuked and you can be a model citizen. until you abuse your body for a couple of decades, the CT won't show anything
>>682713921 psychologically? we'd have to ask him, anon. but presumably his psyche is different from ours as we would not let such a situation progress. we would take a shower. although see >>682712463 this person could have ended up similarly
>>682714502 I second this, you can't just roll in with some bullshit pictures. Epidural hematomas, carotid endarterectomies, and MCA aneurysms can be understood by preclinical medical students. How do I know this? >rhetorical question
>>682714481 the intraop view looks clean so it was likely incidental. when they rupture, there is blood. it looks angry inside and the patient is sick. sometimes you take a pic for some other reason (i got a headache or whatever) and you see it before it ruptures. at that size, you would treat before it ruptures.
>>682714502 see pic hopefully it satisfies your reasonable suspicion
>>682714592 can you take a pic of your MRI and post it? generally speaking, migraines don't have any structural cause that would show up on imaging
>>682715075 Nice. How about some Step 1 review tips? Dedicated 6 week period begins next week. Mapped out 12 day cycles to complete first aid and pathoma 3x by exam day. Also, I've gone through UWorld once already and am making a victory pass
>>682715702 i resisted apple forever but finally drank the kool aid. sold my android. still miss google now, but i think i'll survive.
>>682715888 just hammer that shit in, anon. brute force memorization. it's just another test and ultimately it is worthless and of no measure of what kind of doc you'll be, but it's an easy metric that is used for screening. you don't want it to be an issue if you opt for a more competitive match. ace it and forget it. what are you leaning towards at this point?
>>682716366 C from T medulla? you mean just distinguish axial view of C and T cord? yeah, post columns will tell you. tips: fucking hammer that shit in your brain by looking at endless images. no compromise, anon, no short cuts
Ok doc here's my rundown 28 Raging alcoholic from 18-22 1pack/day smokerx10 years 6' 215lbs Hx Borderline Htn and Hyperlipid Firefighter/Paramedic for work since 20 So for a few years I've always had outward pressure feeling in left rear of skull. Chalked it up to clusters or tension headache. Lately in last 6 months have weird occasions,few seconds in duration, where I feel like something gets stuck in my brain, almost like an air bubble, then goes away. Also have occasions where one whole side of my head and face goes numb for a few seconds. Also have random pains behind left eye . Also had about 3 near syncope episodes in last few months (think anxiety/vasovagal tho). What is causing these stuck and paresthesia feelings?
Separate note, injured left lower back about 6 months ago, never got 100% but got better for a while. Now it spasms alot from bottom of rib cage down to asscheek. Sometimes have random sharp stabbing pains in left leg too, along outer thigh, Tib fib, and sometimes in foot. Never all 3 at once? Thoughts? I've been suspicious I have MS in the past but I'm also a self-diagnosed basket case and feel like I can never find a doc who doesn't think I'm healthy just because CBCs are all normal and I'm young.
>>682716694 Torrented DIT, it's good but if I wanted to get anything out of it, I should have started earlier. Some compiled info being passed around my class said it wasn't as associated with higher scores than First Aid & UWorld. Was considering sketchymicro and sketchypharm but it adds too much to the average day (which takes all day to begin with)
as for OP's reply, which I can't link thanks to Fortune's interface, I've heard it's all about brute force so long as I use a few high yield resources and make multiple passes. Thanks for the pep talk; people build it up like its huge but you're right, it's just another day at prometric. Leaning towards ENT but if I can't produce the step scores, it doesn't mean anything. Keep on doing what you do OP, people like you give me hope that shit will work out
>>682717685 I dunno man I mean I'm 28 I'm unhealthy but not obese or super out of whack vitally. No paralysis with them really, just feels like something getting stuck near my skull/scalp, usually frontal and on the sides of midline. I feel a lot of popping and crackling in my head too like something is tearing.
>>682718235 Definitely UW and FA are the best sources, but like I said, one you've got that down you'll easily finish DIT in a wk and it'll just add to what you know. Step 1 sucks man, it really does, but after that it's easy peasy Japanesy, also Goljans audio is floating around the torrents and it makes for easy points, I would listen to it in the car whenever I drove
>>682717685 In addition the paresthesia feels like when you get a good euohoric rush like when you're listening to a song you love that you really relate to and it gets to the best part, except for it is literally could cut it in half on one side vs how a euphoric rush is usually the whole head.
I don't know if this falls under the expertise of a neurosurgeon, but I skipped a lumbar disc a little over a year ago and I was pretty much crippled until January. PT has helped a lot but I still have intense sciatica and I physically can't run. Am I fucked for the rest of my life? What do?
>>682717330 good on you for not raging with the EtOH now think about cutting back the smoking stay fit those three things will help everything you described to some degree. you know that. good common sense. the 'stuck' feeling sounds odd and an obvious explanation doesn't jump out. any triggers? associated anything? that with the transient paresthesias and the near syncope could be anxiety/vasovagal, but it's worth meeting with your doc to make sure you're BP isn't out of control. TIAs like anon below suggested is on the list. see your doc and get it sorted. for the back spasm and the LLE pain, try doing some stretching/core strengthening/exercise. it'll get back to 100%. if it lingers, see a physical therapist. good luck
>>682717483 yes. they are a pain in the ass bc everything must be disposed of instead of sterilized and put back into regular circulation. so you get worthless instruments and everyone is paranoid and wearing space suits. it's annoying. did 4 biopsies that were neg and one that was actually positive. of course, doesn't mean anything bc they still die like a dog.
>>682718235 good luck w the test, anon kill it and then move on
>>682718329 that sucks. /pol/ is among us, although i've not encountered any professional. maybe they just hide it.
>>682719820 you'll get better, /b/ro. most do without surgery. if the pain gets worse of you feel like your quality of life is totally jacked, meet with a neurosurg to figure if the OR is right for you. otw keep stretching and toning it down while you recover. good luck
>>682722377 The transient paresthesias aren't associated with the near syncope or the air bubble feelings. All 3 are separate and random. I'm like 90% sure that is anxiety. The paresthesia are random. The air bubble feelings are probably stress centered too. The left lower back definitely spasms more when anxious. I think I'm just really tense and anxious especially in my back & neck & that is probably 95% of my problems, but figured while I had free expertise I'd take it. My BP is anywhere from normal/borderline to stage 2 Htn depending on the machine/person taking it but everything else other than my weight is always normal limits. I do have occasional non-perfusing pvcs but they did a full CBC x-ray & echo to rule out PE or cor pulmonale. Thanks for the advice.
I also want to be a doctor, but barely a sophomore, really freaking out about how I'm gonna get into med school b/c I failed a class when I was taking dual credit so I have a shitter GPA, any advice bros?
>>682722096 you still kickboxing, anon? if you have had multiple concussions already, and TBI from a mortar, and you get migraines, you may want to tone down the full contact sparring. if it's not your livelihood, keep training but minimize your exposure to head shots. that could allow you to get the headaches under control but still do the shit you enjoy.
>>682723418 maybe address the anxiety, anon? not with meds but just get your life sorted. you don't need me telling you how to live, but if there are stressors that you can minimize/accept/avoid, do that. also, train more. it clears the mind, will keep the BP good, encourage you to stop smoking and help the back/leg spasms
>>682723916 dude. why you freaking? one bad grade won't tank your chances. meet with your school's advisor to hash out how to make your application look good, roll your dice, and give it a go.
>>682724605 Yeah I am trying I really don't want to go on meds either because then I have to give work a note for benzo+ test exempt and then I'll just feel like they're judging me too, which fear of judgement/acceptance is like 95% of my anxiety.
>>682724604 good question, anon the whole process is funny sophomore bro up there, freaking out about even getting into med school step one prepping anon there, in the mix but unsure of what path to choose what i realized is that you need to make a decision with incomplete information (go to med school; choose whatever speciality for residency, etc), and then once you get where you thought you wanted to be, it's not quite what you imagined. but there you are. i guess that's what life is all about. the only significant way my perspective has changed is that i know (as opposed to suspect) that life is short and we all die, so best to live large/well. sounds cliche but shits true anon
>>682724952 in a week, not many currently. in my career, VPS/EVD numbers in the hundreds. in terms of bang for buck, they are great but i agree, they also blow donkey nuts in their own way just don't clamp that shit and walk away when they go to MRI. i've had people die that way. but i know you wouldn't do that, anon, because you're a /b/tard like us
>>682725147 yeah, you don't need that headache/bullshit, anon. you also don't need the med. just train, get the life sorted, stop smoking. i know, and cure cancer too.
We have to double check everything when it comes to IICP stuff in ICU, too many people have had issues. We had a patient go from a GCS of 14 to a 5 because a dumbass wasn't paying attention. Supratentorial herniation though FM.
>>682727061 scary shit if you're not in a high volume center, it's risky bc the staff doesn't have the experience you think it's possible to train people? or are some just not up to the attention to detail?
>>682726658 Let's say hypothetically the tumor is growing through the left facial nerve and hopped to the acoustic nerves, and it's just slightly too large to gamma. Patient shows only slight droop and a slight loss of hearing.
>>682727553 man im being terrible, we have protocols in place for ICP readings kind of like sliding scale insulin or titrating pressors. Do this if yada yada reading. Its fool proof given you actually take the measurement and do what you need to.
>>682726366 Cheers. Life is short, rn in icu/ecmo game, its bleak to the point of comedy how short life is. I always wonder what surgery knows about life that goes unspoken, most our surg guys are very cool but are so busy its like they never stop to process the job of surgery. That expereince is limited to so few people it makes me curious, you all do the same thing from oil paintings hundreds of years ago, just with evidence.
>>682727450 we will all die, anon will your cyst be the cause? only rarely don't sweat it
>>682727517 it's going in the bucket, anon approach depends on size and how much is intracanalicular, as well as what kind of ENT assist you have
>>682727553 fuck that sucks but it should have been communicated on sign out and the RN should have known it requires q1h charting, etc they get written up/disciplined? or was it buried?
>>682727890 only if the benefits outweighed the risks, anon if it is experimental, it should only be done in the setting of study some lone wolf neurosurg guy did some shit with e coli (no pun intended) in GBM patients last year in calif. guess what? they died. shocker. but bc he behaved criminally, he was blamed and suffered.
Paramedic Anon reporting in, So doc, are you plagued by the rampant stupidity of nurses as well? I'm often dumbfounded by the shit they say. >nursing home patient, guys in full rigor > "give him oxygen he be alright?" >are you fucking kidding me
>>682728441 cheers pic related the history is fascinating some pts ask about the latest/greatest/newest laser/stem cell/dr oz lie/spaceman treatment. i tell them, the old methods in most cases are still the best.
>>682728704 not sure, anon. is this something to flag people that get lots of narc scripts? got bad news for you: the feds are looking to make it even tougher for docs to prescribe opioids
>>682728722 we all choose a path, anon i dig mine, but i wouldn't encourage anyone to pursue it i remember one attending tell me when i was a student, 'if there is anything else you want to do, do that.'
>>682728972 hahaha sigh sup paramed /b/ro there's stupid nurses, there are also stupid docs. some people are just stupid. what i learned is to trust nobody and remember that the hospital is full of a thousand paid assassins. when my family gets admitted, i'm That Guy, squeaky-wheeling in a gentle way.
>>682729021 she's lucky. i hope she never forgets what she did to somebody. as i was taught: it's not the 99 things you do right, it's the one thing you do wrong.
>>682729612 Drug seeker / AMA too many times. It happens, we have a "shit list" too. Basically you only get admitted if you can prove that you are having an issue and you get non-narcotic pain medications. Yes if you have good kidney fx and you're not having a GI bleed toradol works amazingly.
>>682728972 >>682729332 The only real nurses are floor nurses. Even then, it's only more likely to find a good one there.
There's an air of entitlement and arrogance on bad nurses that you can practically taste. Tell them to fuck off if you're a patient. I've even seen doctors do it. It's phenomenal to see them knocked down a few pegs.
>>682730245 sounds like a bad situation, anon what kind of treatment they planning? staged embolization? post a pic with the name blacked out. pick an axial view the looks the worst. if there is a 3D recon or an angio, just pick the view that looks the most fucekd.
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