Comments by "Stephen Villano" (@spvillano) on "Chubbyemu"
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Dilaudid is legal in every state, as it's medically necessary for treatment of severe pain, such as post-operative pain.
Narcotics are like guns, legal in every state and just as potentially dangerous and just as useful on occasion.
The biggest difference being, a firearm can get me meat for dinner, a narcotic can't get me a damned thing to eat, but can keep me from having a stroke or heart attack from pain (or even limit damage from pain from a heart attack (yes, pain can actually kill you)).
I don't know if it's fortunate or not, but I've a legendary tolerance for ethanol. Despite drinking enough to rival a Marvel comic book god, no liver dings or pancreatitis. No hangovers either.
Fortunately for me, drinking so tends to bore me and I'll just toss the bottle into a closet to be forgotten for months on end.
But, I do know quite a few substance abusers and can emphasize the pain. Best wishes on your recovery, which is its own agony, day by day.
But, I did learn one thing in the military above all other things, pain is nature's way of telling you that you ain't dead yet, keep on living and thriving. Fight for life and if you feel the need too badly, contact me immediately.
For the record, I love narcotics. Can't tolerate them, but love them for their utility medically. I tend to flood with histamine when dosed, so literally go into shock from vasodilation (blood vessels open up wide, due to histamine, dropping blood pressure into the basement). And I'm chronic GERD, so booze isn't quite so fun either.
And blew a disc in my lumbar region, courtesy of not observing something I literally trained thousands against - never catch a patient, help lowering them to the floor and summon help. Wife collapsed hours post-op from gallbladder removal, I caught her and 440 went down both cheeks to the balls of my feet.
Hence, my near-addiction for NSAIDs. ;)
My thoughts when the disc failed?
You. Dumb. Mother. Fucker.
Couldn't even manage to express an exclamation point at the time. Too busy not dropping her, out of concern for mutual damage.
Hilariously, she regained consciousness once I did get her to the floor, so she was able to help me to the bed in the next room.
Lost her a year and a half ago, after 41 years.
Excuse me while I crawl into my bowl of spinach. Really. Made a really nice batch last night, got some leftover and well, I do need to eat.
Shit happens, you learn how to deal with it by remaining conscious. My trick, learning how to cook well, but then one other qualification I've got is, I'm a reformed chef.
Reformed, as really, the pay vs labor ratio totally sucks.
Now, excuse me, I really want to enjoy that spinach. Garlic, onion sauteed, a dab of chicken bouillon, dump in some spinach, cook and enjoy.
Like many recipes, simplicity itself, my recipes even more so, as quantities of spices are entirely to taste - yours, not mine, dammit.
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Sadly, after multiple deployments and finally retiring, contracted in the Persian Gulf region and a handful of years in, forgot to bring water on the commute to base. Got stuck in traffic, AC was inop, got a heat stroke. Hit the gate, at first they thought I was drunk. At the MP station, while being questioned and given a half dozen bottles of water, stopped slurring and a look of horrified realization appeared on their faces and an offer of transportation to clinic was given.
A bit late now, it's over. I was a medic.
Elevated liver enzymes, BUN high, high creatine and protein in urine. All resolved, save for mild protein in urine and ECG analyzer cries out digitalis effect due to QT anomaly.
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PCOS is a complex issue that medicine has finally found the root of, if not an ultimate solution to cure for.
Confounding diagnosis is age of onset for significant signs, which can range from adolescence for a few, through successful childbearing and multiple pregnancies, then the hormones finally are decompensated against and full onset occurs.
It's also a topic of interest for me, as my wife had the latter version, having two live births, out of 16 pregnancies, one abortion induced by a motor vehicle accident, the rest spontaneous abortions.
As well as being diagnosed in our youngest and our eldest has suggestions of it.
Lord, I hate endocrine problems! Other than extremely common OB/GYN, all I usually dealt with were structural damage, plumbing leaks and various infections.
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Ah, but is that burger still in your mind?
Poor soul, have some of my brunch, spinach, sauteed with garlic, a bit of chili pepper and chicken bullion. Leftovers from last night's junk food dinner of mac and cheese with some ham added, comfort food.
Tonight will be clams and linguini in white sauce. Preparation time, maybe a half hour, consumption time, mere minutes. ;)
Recipe is simple, olive oil, garlic to taste (there's no such thing as too much garlic for me), onion, a bit of basil, saute till onions and garlic are cooked, add clam juice and clams, cook the pasta, drain pasta (yeah, some need to be reminded), add sauce, enjoy.
And there's also no such thing as too much onion. ;P
Red sauce is similar, garlic, onion in copious quantities, want it sweeter, add more onion, tomatoes (canned crushed or feel free to blanch and peel fresh tomatoes, some whole tomatoes to preference, loads more basil (I tend to use fresh frozen, sectioned off in a quart container and wax paper separating leaf layers, but dried works too), chili pepper to taste, add meat with fat and hopefully bones to thicken and flavor, cook until the meat falls off of the bones and the oil and fat puddles, foam being now gone, sauce is done.
I make the red sauce in two gallon batches for home, all stored in quart containers, frozen or canned in my pressure cooker. Preparation time, well, pretty much all day. The stove does most of the work, I just have to stir occasionally. ;)
Most good recipes are fairly simple, preparation and cooking tend to be the greater pain in the ass.
But, like any relationship, well worth the effort.
Sponsors be doubly damned.
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I noticed a long time ago, if I diluted soda even up to 50% by volume with water, I really couldn't easily tell the difference between the diluted and straight, other than by viscosity.
OK, at nearing the 50% point, it did grow more tolerably sweet.
I'll stick to having my water without sugar, flavoring crap or carbonic acid. Largely, straight from the tap, as the city's nice enough to filter and treat it.
And before someone complains that they want chemical free water, drinking a vacuum is bad for the GI tract, as water's also a chemical.
Yeah, I've heard that drivel of a complain before, telling me simply, I'm speaking with an idiot who is seeking a new village.
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The morphine in the urine is quite low as well, as in poppyseed roll consumption could easily account for its presence.
You didn't cover one additional probable factor in the fentanyl level in his blood, tolerance from repeated usage. I had to look up the levels, as you did, that likely was right in his dosage profile, so obviously wouldn't have been a major contributing factor in his death.
If memory serves, fentanyl has a lower respiratory depression curve than most other opioids and opiates.
Frankly, I can't tolerate the entire class well, get heavy congestion when my mast cells dump from the opiates or opioids. BP stays OK, but I still feel miserable as hell.
Thanks for the excellent presentation!
Tomorrow, I get to break in my new doctor. It should be fun all around. :)
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Had a spider bite, likely from a hobo spider. They'll deliver envenomation like a mild version of recluse venom. Mild inflammation, sunken area, took months to fully heal, but totally painless and zero systemic symptoms or significant eschar. It resolved uneventfully and I identified the hobo spider, as I saw one previously in the bedroom and subsequently on our bed.
I relocated it away from the domicile, where it could hunt for insects. One downside of having a bedroom right next to the back door of the house.
NW Louisiana, yes, recluses are there, but never saw one in the house, only the occasional hobo spider.
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@palomathereptilian I'd say oddly, save that I know precisely why I have an aversion to any medication.
Speaking as a primary, on site EMS practitioner, well, I'm both extremely conservative and adventurous, depending upon very specific conditions.
Typically, the least intervention delivers the least side effects and problems, but in some patients, more intervention is required to simply get them evacuated to a definitive care facility.
The worse, under that context, took 12 hours of intensive interventions, over a simple severe allergy event, which consumed the entirety of a Battalion medical supply. One bee sting resulted in depletion of the treatment for many conditions, for over 1200 men.
And was the most exhausting day of my life.
As for the remarked upon case, she'd have been equally served by not bothering to eat.
I do that, on occasion. Not out of disorder, but out of lack of activity.
Not busy at all, idle beyond couch potato? Not hungry level, go for base mineral nutrients, hydrate as needed, call it a day.
I'm not underweight, not overweight, "just right" to end up the eldest male in my paternal line of the family to not be type II diabetic. By decades.
While taking a beta blocker, calcium channel blocker and a thyroid blocker, due to severe hypertension and Grave's disease hyperthyroidism.
Another pill? Doc, do make a very serious case for it. Did opioids for a significant issue, the histamine response sucks, badly! Got a better ploy?
Annoyingly, no.*
*Opioids and opiates tend to share a common effect, activating mast cells, resulting in a massive release of histamine.
Inject a patient with morphine, get vomit on your boots, decrease in blood pressure and respiration.
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