# Ask a doctor anything.



## Serenitylala

I have been on this forum for a little while and as a physician, I have been asked medical questions here and there in different threads, so I felt it is high time to open a thread specifically for medical questions. During our hospital or clinic hours, doctors don't have the time to answer questions. I'm a traveling physician so I have some time at night to answer questions. 



*Ask anything you want. *




_Disclaimer: this thread does not constitute a patient-provider relationship. Many things you should see your own primary care provide for, since they are more familiar with your personal medical conditions, medications, and lab results. Always, always, always discuss everything with your own healthcare provider before trying it.

Also, Please refrain from using real names here to avoid violating people's medical privacy if asking for someone other than yourself._


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## LayMeDown

I recently read a disturbing article online that masturbation can damage the tissues inside your penis which can lead to a smaller penis size... is this true?!


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## Stelmaria

Do you believe that the placebo effect has proven physiological effects on medical illnesses and do you believe that it is ethical to dispense a placebo in clinical practice?

How long do you and your colleagues typically spend consulting a patient? Do you feel this is enough time to properly understand what is going on and to deliver the best service you can?

Do you have direct access to the scholarly medical literature (as you had during med school)?
How do you and your colleagues stay up to date on the medical developments in your field? How much time do you spend per week keeping up to date?

Do you believe that the mechanisms of most prescription drugs are well-characterised in humans and does it matter?
What is your take on the evidence based medicine vs science based medicine debate?

What is your opinion on patients who seek second (or third) opinions? Do you think that 'health care seeking behaviour' indicates something else (eg a psychological disorder)?


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## Pillowish

I heard that major pharmaceutical companies were setting a time limit on how long doctors review their patients. Is that true?


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## Serenitylala

LayMeDown said:


> I recently read a disturbing article online that masturbation can damage the tissues inside your penis which can lead to a smaller penis size... is this true?!


Excessive masturbation can lead to inflammation of the penis, leading to erectile dysfunction and inability to ejaculate. The penis was never really designed to be yanked. So it will develop scar tissue and problematic inflammation.


Also, there have been studies that link excessive masturbation to prostate cancer, but in all honesty if you are male and live to be above 80 years old, you most likely will get prostate cancer anyway... Excessive masturbation leads to prostate cancer at a much earlier age.


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## Serenitylala

Snowy Leopard said:


> Do you believe that the placebo effect has proven physiological effects on medical illnesses and do you believe that it is ethical to dispense a placebo in clinical practice?


I don't adhere to the belief that a placebo is ethical... But yes, the placebo effect is real. The same way there is a real physiological affect from touch or from music. The body is self healing. There have been many studies that demonstrate that happier people are less likely to catch colds then depressed people when administered the same cold virus. So there is something to be said about the brain being able to produce healing effects from the belief that one is receiving treatment.



Snowy Leopard said:


> How long do you and your colleagues typically spend consulting a patient? Do you feel this is enough time to properly understand what is going on and to deliver the best service you can?


I spend longer than most because every aspect of the patient is meaningful to me. I typically spend an hour. But I don't believe that any amount of time is ever sufficient to properly understand what is going on. But this is where our extensive training and years of study come into play. This is why it is known as the art of medicine. 

But I do try my hardest to deliver the best care possible to my patients, because it isn't about me, it's about them. 



Snowy Leopard said:


> Do you have direct access to the scholarly medical literature (as you had during med school)?
> How do you and your colleagues stay up to date on the medical developments in your field? How much time do you spend per week keeping up to date?


Yes. I always have access wherever I go. Also our professional societies keep us up to date on the newest literature. I'm constantly studying even though I'm no longer in school. There also is a site called Up To Date that we always have access that publishes the most recent literature continually. I probably spend two hours a day, but I'm lazy. I have a colleague who studies extensively.



Snowy Leopard said:


> Do you believe that the mechanisms of most prescription drugs are well-characterised in humans and does it matter?
> What is your take on the evidence based medicine vs science based medicine debate?


Pharmacies are not always accurate nor do they characterize the mechanisms effectively. We have much evidence of this in all the litigations from faulty drugs or medical equipment.

As for evidence based medicine, I work exclusively by it. But there are cases when anecdotal evidence is just as good. I'm more in the middle of the debate and young enough in my career that I haven't completely taken a side. I'll have to get back to you more on the issue when I have more time.



Snowy Leopard said:


> What is your opinion on patients who seek second (or third) opinions? Do you think that 'health care seeking behaviour' indicates something else (eg a psychological disorder)?


I agree with second and third opinions. It is the patient's life after all. As for health care seeking behavior, very rarely is it a true psychological disorder. People know their bodies... If I am unable to diagnose it or other doctors haven't diagnosed it, it doesn't mean that it doesn't exist, and I personally will keep looking for answers.


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## Serenitylala

Pillowish said:


> I heard that major pharmaceutical companies were setting a time limit on how long doctors review their patients. Is that true?


No, that's the insurance companies, and the new changes to the Obamacare established home care model. Doctors are required to see twice as many patients per day to make ends meet. I don't know very many rich doctors anymore.

Reimbursements are 60% less than they were just five years ago.


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## Bugs

^ I couldn't resist the pun. 


Do you prefer to travel or would you rather have your own doctor's office?


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## Bugs

It seems to me that doctors are motivated to prescribe meds at the slightest sign of a minor sickness such as a cold. IMO part of this is attributable to incentives created by insurance companies where a check up ( with insurance) is only 10-25 dollars co-pay. Is there an incentive for doctors to prescribe as much as possible?


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## Bugs

What motivated you to go to med school and become a doctor? Was it always an ambition of yours sort of like the kid dreaming of being a doctor? Do you think school is too long and expensive? Do you think there is too much, too little , or just the right amount of barriers to entry? Do you believe a certified nurse or someone with credible medical experience ( but not necessarily an M.D.) could treat people for routine check ups and family medicine?


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## Serenitylala

Bugs said:


> ^ I couldn't resist the pun.
> 
> 
> Do you prefer to travel or would you rather have your own doctor's office?


Lol. I liked it!

I would prefer my own clinic, but that takes time to establish. So for now I travel. Besides I get to go to places where people need the most help.


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## Serenitylala

Bugs said:


> It seems to me that doctors are motivated to prescribe meds at the slightest sign of a minor sickness such as a cold. IMO part of this is attributable to incentives created by insurance companies where a check up ( with insurance) is only 10-25 dollars co-pay. Is there an incentive for doctors to prescribe as much as possible?


Most physicians are trained only in pharmaceuticals. I'm not. I'm trained in extra modalities. Yet, there are no kick backs for doctors to prescribe medications, pharmaceutical companies can't even give physicians pens anymore. But that being said, there are government regulated guidelines for "standard of care" that forces physicians to write certain prescriptions, such as statin drugs. These are forced prescriptions and if a lawsuit appears, you can be held seriously liable if you didn't prescribe them.

I personally offer all different options to my patients. They then choose and then I document their decision. I offer all my medical advice both pros and cons then make suggestions and then let them decide. It's their life not mine. Personally, I am against many of the medications out there but I am also a supporter of the use of many others.


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## Serenitylala

Bugs said:


> What motivated you to go to med school and become a doctor? Was it always an ambition of yours sort of like the kid dreaming of being a doctor? Do you think school is too long and expensive? Do you think there is too much, too little , or just the right amount of barriers to entry? Do you believe a certified nurse or someone with credible medical experience ( but not necessarily an M.D.) could treat people for routine check ups and family medicine?


Well... I had open heart surgery to repair a congenital valve defect and there after wanted to be a doctor to help people. That was my motivation for making it as an ENFP through the hell that is medical school and residency. Most physicians do enter medicine to want to help people. I just know what it is like to be a patient.

School is very very very expensive and arduous, but the length of time, seemed to go by quickly. I don't mind dedicating years of my life to helping people through medicine. That part didn't bother me. But if you asked me whether or not a person should go into medical school, I'd say become a PA or a nurse practitioner, it is less expensive and you don't have to go to residency programs.

Too many barriers to entry at the residency level. Last year there were three times the applicants as there were spots in residency programs across the United States, thus leaving two thirds of the applicants with no way to use their medical career and having a huge amount of debt. It was awful to watch.

Lastly, one of my favorite health care providers is a nurse practitioner. I'm all for individual know how and experience over degree. I've met some brilliant nurses and some stupid--arrogant physicians. It depends on the person.


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## Bugs

Serenitylala said:


> Lol. I liked it!
> 
> I would prefer my own clinic, but that takes time to establish. So for now I travel. Besides I get to go to places where people need the most help.


What kind of places do you travel to?



> Most physicians are trained only in pharmaceuticals. I'm not. I'm trained in extra modalities. Yet, there are no kick backs for doctors to prescribe medications, pharmaceutical companies can't even give physicians pens anymore. But that being said, there are government regulated guidelines for "standard of care" that forces physicians to write certain prescriptions, such as statin drugs. These are forced prescriptions and if a lawsuit appears, you can be held seriously liable if you didn't prescribe them.


I find this kind of disturbing. Can't one interpret this as government trying to benefit big pharma by giving them effective subsidies? As a physician , how do you feel about this? 



> I personally offer all different options to my patients. They then choose and then I document their decision. I offer all my medical advice both pros and cons then make suggestions and then let them decide. It's their life not mine. Personally, I am against many of the medications out there but I am also a supporter of the use of many others.


So do you work as a concierge? Do you accept insurance? Are doctors encouraged to charge a very high amount for their services because people with insurance have their insurance pay a very high amount even for just a check up/visit? I think you get what I'm saying but for others my point is that those of us with insurance that pay just $25 or so of co pay for a visit doesn't mean the doctor earns just $25 for that visit. Doctor's office is actually charging maybe 150% more of the co pay amount rounding off to about $75-$100 for the same visit not including any blood work or extra care. Do you think the system is rigged so doctors charge too much ( since its not determined by a free market) , or are there regulations that actually require you to charge so much? Do you think its justified?

Btw , I'm not trying demonize doctors in any sense but I am curious of more doctors' opinions on the current state of healthcare.


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## Bugs

Serenitylala said:


> Well... I had open heart surgery to repair a congenital valve defect and there after wanted to be a doctor to help people. That was my motivation for making it as an ENFP through the hell that is medical school and residency. Most physicians do enter medicine to want to help people. I just know what it is like to be a patient.


That's admirable to use your own experience to help others. roud: I have an ENTP friend that made it through medical school and said pretty much the same thing. Ne is an impatient virtue :tongue:



> School is very very very expensive and arduous, but the length of time, seemed to go by quickly. I don't mind dedicating years of my life to helping people through medicine. That part didn't bother me. But if you asked me whether or not a person should go into medical school, I'd say become a PA or a nurse practitioner, it is less expensive and you don't have to go to residency programs.


Any theories to why school is so expensive? Personal question , did you take loans ( if so , are you still paying them off , and how long do you project you will have to do this?) or did you have a source of income to fully pay off your school? 



> Too many barriers to entry at the residency level. Last year there were three times the applicants as there were spots in residency programs across the United States, thus leaving two thirds of the applicants with no way to use their medical career and having a huge amount of debt. It was awful to watch.


This is what I heard. Are these barriers ultimately dictated by the AMA or some other bodies? Finishing med school then sounds like a risky crapshoot , doesn't it? I mean if you only have a 1/3 chance of starting your career what is the incentive for students to stay with it? 



> Lastly, one of my favorite health care providers is a nurse practitioner. I'm all for individual know how and experience over degree. I've met some brilliant nurses and some stupid--arrogant physicians. It depends on the person.


Are there not laws in place to strictly limit the ability for non M.D. individuals to service peoples' health needs? Who dictates these rules?


Thanks for all your replies. Very informative


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## Serenitylala

Bugs said:


> What kind of places do you travel to?


I travel everywhere across the US, but I prefer the cold of the mountain west or upper New England. I avoid the south.



Bugs said:


> I find this kind of disturbing. Can't one interpret this as government trying to benefit big pharma by giving them effective subsidies? As a physician , how do you feel about this?


I'm not sure to tell you the truth, but I don't like it nor do I think it is beneficial to the patients. On the other hand there should be standards of care, but not forced drug usage.



Bugs said:


> So do you work as a concierge? Do you accept insurance? Are doctors encouraged to charge a very high amount for their services because people with insurance have their insurance pay a very high amount even for just a check up/visit? I think you get what I'm saying but for others my point is that those of us with insurance that pay just $25 or so of co pay for a visit doesn't mean the doctor earns just $25 for that visit. Doctor's office is actually charging maybe 150% more of the co pay amount rounding off to about $75-$100 for the same visit not including any blood work or extra care. Do you think the system is rigged so doctors charge too much ( since its not determined by a free market) , or are there regulations that actually require you to charge so much? Do you think its justified?


Most doctors are salary or hourly based. Hardly any physicians anymore charge patients directly, except those that own clinics. I don't accept insurance nor do I like receiving money from patients themselves because it makes me feel dirty. I am hourly based through a third company that pays my travel and malpractice insurance.


As for all insurance payments, they are dictated by the centers for Medicaid and Medicare service or CMS reimbursements schedule. Some insurance companies will pay more but that is rare anymore due to the change in Obamacare... It has increased insurance premiums to the populace by 138%... No joke. But it at the same time decreased reimbursements to hospitals and healthcare providers. So where is all the money going? Well it's a tax. Unfortunately, the poor and middle class are suffering the most because their so called insurance refuses to pay for most of the treatments they need and there is nothing the physicians can do about it. I have fought alongside case management to get cancer treatment for someone on so called Obamacare. It was awful. There was nothing I could do... It was horrible.



Bugs said:


> Btw , I'm not trying demonize doctors in any sense but I am curious of more doctors' opinions on the current state of healthcare.


Lol. I demonize doctors myself. Lol. I used to want to be a malpractice attorney against doctors but now am one. I do what I can to fight the good fight for my patients. So as you can see I am one of the poor doctors... My brother makes fun of me for constantly working for free.

I love free clinics, those are places that truly care, not this horrible Obamacare which has sent many patients to tears or their deathbeds because of its barriers.


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## Serenitylala

Bugs said:


> That's admirable to use your own experience to help others. roud: I have an ENTP friend that made it through medical school and said pretty much the same thing. Ne is an impatient virtue :tongue:


Lol. Impatience is my virtue. ;-) 

Seriously though, medical school and residency are hell. You have to really want it, and as an. NFP, you have to fight the uphill battle with everyone telling you how stupid you are because you don't do things the way they do. (I have an IQ of 149... So I just grin and bear it, especially when I hear that they have IQs in the 120s.)



Bugs said:


> Any theories to why school is so expensive? Personal question , did you take loans ( if so , are you still paying them off , and how long do you project you will have to do this?) or did you have a source of income to fully pay off your school?


I'm not sure really. There really isn't any reason for it. I can tell you that 2/3 of my class were self pay, because they came from wealthy families. I found out because one of the jobs that I worked during medical school was in the financial aid office.

I took out loans and earned scholarships. Even with the scholarships, I am $345,678.90 in medical school debt. So no gravy train is coming for me anytime soon.  it will be a while before I am free of debt.



Bugs said:


> This is what I heard. Are these barriers ultimately dictated by the AMA or some other bodies? Finishing med school then sounds like a risky crapshoot , doesn't it? I mean if you only have a 1/3 chance of starting your career what is the incentive for students to stay with it?


These barriers were actually created by the Centers for Medicaid and Medicare Services (CMS). This is the governing body over the salaries for residency programs. This organization places a cap on how many resident spots can be filled per year. In 2012, the number of open spots dropped due to inability of CMS to pay for their salaries. This has been stable, but many more medical schools are opening their doors and sending out more medical students per year. Despite the surge in medical students and the increasing need to serve the population, the CMS has kept a tight leash on residency programs.

This was done to increase the number of graduating mid levels (PAs and NPs) and to decrease the number of physicians in order to justify the new home care model. One physician and several mid levels under him or her.

Some states have compensated like Missouri, by providing licenses to medical school graduates that haven't received a residency program diploma. But this effort has been blockaded by insurance companies that won't credential physicians that are not board certified (which a doctor needs to finish a residency program in order to obtain). Also the number of international medical graduates has increased, and CMS pays much more to hospital residency programs for an IMG resident than an American born resident due to a law passéd by the current administration for education increases for foreigners. That I think was a good thing, but they should have increased spots overall.

The incentive to continue for medical students is their love for medicine or desire to help people in general.



Bugs said:


> Are there not laws in place to strictly limit the ability for non M.D. individuals to service peoples' health needs? Who dictates these rules?
> 
> 
> Thanks for all your replies. Very informative


The government not the AMa or the AOA. There are not as many laws governing mid levels as there a governing physicians (MD and DO). (Btw, DOs are doctors of osteopathy that ar exactly like MDs but receive 7 hours of training more per week during their medical school careers learning something known as osteopathic manipulation therapy.)


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## Serenitylala

Bugs said:


> That's admirable to use your own experience to help others. roud: I have an ENTP friend that made it through medical school and said pretty much the same thing. Ne is an impatient virtue :tongue:


Lol. Impatience is my virtue. ;-) 

Seriously though, medical school and residency are hell. You have to really want it, and as an. NFP, you have to fight the uphill battle with everyone telling you how stupid you are because you don't do things the way they do. (I have an IQ of 149... So I just grin and bear it, especially when I hear that they have IQs in the 120s.)



Bugs said:


> Any theories to why school is so expensive? Personal question , did you take loans ( if so , are you still paying them off , and how long do you project you will have to do this?) or did you have a source of income to fully pay off your school?


I'm not sure really. There really isn't any reason for it. I can tell you that 2/3 of my class were self pay, because they came from wealthy families. I found out because one of the jobs that I worked during medical school was in the financial aid office.

I took out loans and earned scholarships. Even with the scholarships, I am $345,678.90 in medical school debt. So no gravy train is coming for me anytime soon.  it will be a while before I am free of debt.



Bugs said:


> This is what I heard. Are these barriers ultimately dictated by the AMA or some other bodies? Finishing med school then sounds like a risky crapshoot , doesn't it? I mean if you only have a 1/3 chance of starting your career what is the incentive for students to stay with it?


These barriers were actually created by the Centers for Medicaid and Medicare Services (CMS). This is the governing body over the salaries for residency programs. This organization places a cap on how many resident spots can be filled per year. In 2012, the number of open spots dropped due to inability of CMS to pay for their salaries. This has been stable, but many more medical schools are opening their doors and sending out more medical students per year. Despite the surge in medical students and the increasing need to serve the population, the CMS has kept a tight leash on residency programs.

This was done to increase the number of graduating mid levels (PAs and NPs) and to decrease the number of physicians in order to justify the new home care model. One physician and several mid levels under him or her.

Some states have compensated like Missouri, by providing licenses to medical school graduates that haven't received a residency program diploma. But this effort has been blockaded by insurance companies that won't credential physicians that are not board certified (which a doctor needs to finish a residency program in order to obtain). Also the number of international medical graduates has increased, and CMS pays much more to hospital residency programs for an IMG resident than an American born resident due to a law passéd by the current administration for education increases for foreigners. That I think was a good thing, but they should have increased spots overall.

The incentive to continue for medical students is their love for medicine or desire to help people in general.



Bugs said:


> Are there not laws in place to strictly limit the ability for non M.D. individuals to service peoples' health needs? Who dictates these rules?
> 
> 
> Thanks for all your replies. Very informative


The government not the AMa or the AOA. There are not as many laws governing mid levels as there a governing physicians (MD and DO). (Btw, DOs are doctors of osteopathy that ar exactly like MDs but receive 7 hours of training more per week during their medical school careers learning something known as osteopathic manipulation therapy.)


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## Eska

I haven't been able to find something precise regarding my concern due to my lack of precise wording, hopefully you'll be able to pinpoint the matter.

Towards the lower end of my left trapezius (borders on my latissimus dorsi), about 6 times a day (2 times when I'm resting, 4 times when I'm training), I'll feel what I would describe as an electric spark, like a tiny needle quickly flying through that area. 

Months ago, that area used to have a "fuzzy" feeling that would occur at random about 4 times a day (training or not), like microscopic ants walking over the area, it was painless, but now, it changed to what I've described above.

*To clarify, it doesn't stop me from doing anything, nor is it significantly bothersome, it's simply odd and I'd like to be aware of what might be causing this, and if measures need to be taken before it could potentially get troublesome.

*The green area in the following image;









Would it be safe to assume it's a pinched/damaged nerve?

Whatever the case may be, what treatments would you recommend?


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## Serenitylala

Eska said:


> I haven't been able to find something precise regarding my concern due to my lack of precise wording, hopefully you'll be able to pinpoint the matter.
> 
> Towards the lower end of my left trapezius (borders on my latissimus dorsi), about 6 times a day (2 times when I'm resting, 4 times when I'm training), I'll feel what I would describe as an electric spark, like a tiny needle quickly flying through that area.
> 
> Months ago, that area used to have a "fuzzy" feeling that would occur at random about 4 times a day (training or not), like microscopic ants walking over the area, it was painless, but now, it changed to what I've described above.
> 
> *To clarify, it doesn't stop me from doing anything, nor is it significantly bothersome, it's simply odd and I'd like to be aware of what might be causing this, and if measures need to be taken before it could potentially get troublesome.
> 
> *The green area in the following image;
> 
> 
> 
> 
> 
> 
> 
> 
> 
> Would it be safe to assume it's a pinched/damaged nerve?
> 
> Whatever the case may be, what treatments would you recommend?


Without doing a physical exam on you, it is hard to say. But I personally believe from what you describe, there could possibly be a subluxated rib in that region. The possibility that it is a pinched nerve is low do to the fact that the pain you are describing doesn't radiate along the nerve path which would travel around to the front of your torso or would shoot down your spine.

I highly recommend you going to a neuromuscular medicine specialist... Or in other words a doctor of osteopathy that does OMT... The doctor could be a family practitioner DO or a NMM specialist DO.

To help reduce the inflammation,( if you don't have any inflammatory bowel disease, GERD, or peptic ulcer disease or on any medications that would interact with it) would be to take turmeric or otherwise known as cur cumin which is a spice that has been shown in studies to reduce inflammation and neuropathic pain.

But yours is a situation that requires a physician to take a look at you hands on. You might need a rib moved back into place, or a rigger point injection. But I really can't say without looking at you in person.

Highly recommend you seeing a DO physician with OMT experience. They should be able to treat you quickly.


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## Humilis Curator

First off, you're a wonderful person. 

I am a 26 year old 6 ft tall male and I have been overweight to obese for the majority of my life, peaking around 260. The past several months I have lost ~60 lbs and am now 199. I have become absolutely addicted to running and I enjoy it thoroughly. However, I worry that due to my history of being heavy that my legs/feet/knees will deteriorate and prevent me from enjoying running and hiking which I have found a love for. What are some simple things/tips that I can do on a regular basis to help care for them long term, specifically my knees. I never get pain in them anymore after a good run where I've pushed myself, the only time I ever experience pain is in my knees when I am doing squats at the gym but it is very minor and it even subsides after a few reps. 

Thank you in advance.


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## Stelmaria

What is your perspective on "medically unexplained illnesses"? Especially given the continued new discoveries in medical science?


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## mhysa

Red Panda said:


> Did anything happen in your life now? something that has added stress, whether good or bad?
> Cravings for specific foods is psychological though some say it can be attributed to certain deficiencies, but I'm not sure I believe it.


no, if anything i've actually been much more relaxed for the past few weeks since i haven't had school. maybe i just want to eat a lot because i'm bored? i've heard of some people developing that habit. but i always FEEL physically hungry, so it's really strange.



Serenitylala said:


> In a woman, there are a we're things that would cause this: one, stress/anxiety.. But that is ruled out because you would have mentioned being depressed or stressed.
> 
> The second and most common cause of excessive eating in a female is a spike in progesterone. Progesterone actually increases your metabolism but it also makes you insatiably hungry. This is the reason why diets, if started during the progesterone phase of a woman's cycle will always fail.
> 
> Increases in Progesterone are part of the reason why pregnant women constantly get hungry.


maybe the progesterone could be it. is there any particular reason i could be getting a spike like that or does it just happen to women sometimes? it's getting pretty close to "that time of the month" so maybe that has something to do with it.


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## VinnieBob

Serenitylala said:


> Tell me what your aura was like.


according to DR quack it was pulsating. 5 ft out then receding back into me bod
the ''auralogist'' was using a pendant, dr hack mcquack would then ask aura boy a question and if the answer was positive the pendant would swing clockwise 5 x
if negative counter clockwise 5 x the problem was I was staring at little aura annies hand and could see him moving [guiding] his thumb and index finger thus guiding the force

ironically before I became ill my diet was purely organic foods
I made all my soups, sauces, everything from scratch
my diet was 90% fruits/vegetables often eating them raw


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## Reluctanine

@Serenitylala

Woah, awesome thread! Thank you for taking the time to answer all the questions. It was a really informative and touching read. Could see the passion you have for helping others. 

So, my questions are:

Where do you see medicine heading in future?

Where would you like to see medicine heading in future?


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## Serenitylala

Reluctanine said:


> @Serenitylala
> 
> Woah, awesome thread! Thank you for taking the time to answer all the questions. It was a really informative and touching read. Could see the passion you have for helping others.
> 
> So, my questions are:
> 
> Where do you see medicine heading in future?
> 
> Where would you like to see medicine heading in future?


The field of medicine has so many components to it that it makes the future of it hard to see. There's the political component that is moving towards less physicians and more mid-level providers. For instance by 2025, their will be only 25% of the cardiovascular surgeons that are needed to handle the increasing number of cases, but there will be three times as much Cardiovascular PAs.


In terms of technology, the advances are pushing the limits of robotics. For instance, physicians can carry around their own ultrasound machines in their iPads. All that is needed is a transducer attachment. 

In terms of availability to the patients, it will decrease. With Obamacare, patients are receiving much less coverage overall for the tests, procedures, and medications that they need. I've watched countless cases where patients will say, 'my insurance won't cover this medication and now, I don't know what to do." The medications and tests that are not being covered have increased every year since the affordable care act (Obamacare) was enacted. It's horrifying to watch.


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## Serenitylala

Jeff Felis said:


> How do you feel about drug representitives visiting doctors in their offices, marketing meds to them, giving them medication samples and treats such as a box of muffins or Starbucks coffee ect? Is this ethical behavior in your opinion?
> 
> Also, how do you feel about the marketing of prescription medications on television and the radio?


It never affects my decision making, so I really don't care about it. I consider medications the same as any other product. Advertise and promote their product all they want, but unless I have seen evidence that it is effective and harmless, I will not prescribe it.


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## Serenitylala

Humilis Curator said:


> First off, you're a wonderful person.
> 
> I am a 26 year old 6 ft tall male and I have been overweight to obese for the majority of my life, peaking around 260. The past several months I have lost ~60 lbs and am now 199. I have become absolutely addicted to running and I enjoy it thoroughly. However, I worry that due to my history of being heavy that my legs/feet/knees will deteriorate and prevent me from enjoying running and hiking which I have found a love for. What are some simple things/tips that I can do on a regular basis to help care for them long term, specifically my knees. I never get pain in them anymore after a good run where I've pushed myself, the only time I ever experience pain is in my knees when I am doing squats at the gym but it is very minor and it even subsides after a few reps.
> 
> Thank you in advance.


Thank you for your kind words. Firstly, congrats on your weight loss and exercise. That takes serious dedication.

As for your question: obesity does put stress on joints, but it also increases your bone density. When it comes to cartilage breakdown, it will occur as a natural part of the aging process regardless... And occurs more in anyone that uses their joints in an aggressive repetitive manner... Which includes athletes, carpenters, sculptures, dancers, piano players, etc... Depending upon the joints that are over utilized.

What you can do is concentrate on wearing correct footwear (changing your shoes frequently); running on level ground; correct body mechanics during lifting, running, and other physical activities; eating less amounts of sugar, caffeine, synthetic sweeteners, and avoiding tobacco as well as eating foods rich in protein with their cartilage and rich colorful vegetables; and taking supplements such as glucosamine, chondroitin, turmeric (curcumin), and vitamin/mineral supplements. 

(Just in case anyone was wondering: 

Glucosamine is a healthy sugar protein that is a key component in your body's building of cartilage. 

Chondroitin is also a sugar chain substance that is found in the fluid within your body's joints, helping keep them flexible and protected.

These should not be substituted for your primary care provider's prescriptions, but they are great supplements that help maintain your joints. 

Also, chondroitin and glucosamine can not be taken if you are taking insulin or any blood thinners such as warfarin (Coumadin).

Avoid taking chitosan when taking chondroitin because it decreases the absorption of chondroitin.)


----------



## Serenitylala

Snowy Leopard said:


> What is your perspective on "medically unexplained illnesses"? Especially given the continued new discoveries in medical science?


There are a LOT of things that doctors don't know. At least calling it a "medically unexplained illness" gives the patient the respect they deserve, many practitioners will label something that they don't know anything about as being "in the patient's head."

So for the record, I believe that there are a lot of things that are not able to be medically explained at this time. If we cannot create life from nothing or stop the aging process and death altogether, then we are still always lacking in medical advancement.


----------



## Serenitylala

mhysa said:


> no, if anything i've actually been much more relaxed for the past few weeks since i haven't had school. maybe i just want to eat a lot because i'm bored? i've heard of some people developing that habit. but i always FEEL physically hungry, so it's really strange.
> 
> 
> 
> maybe the progesterone could be it. is there any particular reason i could be getting a spike like that or does it just happen to women sometimes? it's getting pretty close to "that time of the month" so maybe that has something to do with it.


Just happens. Just chalk it up to being a woman. When progesterone is high, women feel relaxed and are peaceful. She is also highly attractive to men. Darker days increase progesterone production, so women can biologically adapt to the winter. Then when progesterone levels drop in a woman's cycle, menses begins.


----------



## Serenitylala

vinniebob said:


> according to DR quack it was pulsating. 5 ft out then receding back into me bod
> the ''auralogist'' was using a pendant, dr hack mcquack would then ask aura boy a question and if the answer was positive the pendant would swing clockwise 5 x
> if negative counter clockwise 5 x the problem was I was staring at little aura annies hand and could see him moving [guiding] his thumb and index finger thus guiding the force
> 
> ironically before I became ill my diet was purely organic foods
> I made all my soups, sauces, everything from scratch
> my diet was 90% fruits/vegetables often eating them raw


That visit must have been beyond disappointing. I am so sorry for all that you have gone through. What an awful experience. I am still calling around to see if any specialists have any idea of where to begin with you. We do all agree that you need to have nutrient infusions while we are trying to find the trigger for your condition.


----------



## VinnieBob

Serenitylala said:


> That visit must have been beyond disappointing. I am so sorry for all that you have gone through. What an awful experience. I am still calling around to see if any specialists have any idea of where to begin with you. We do all agree that you need to have nutrient infusions while we are trying to find the trigger for your condition.


thank you and happy new years


----------



## Metalize

Hello,

This has been a very informative thread, both in terms in medical information from a physician, and understanding the intricacies of the system you come from.

I have a question ... As of a couple of days ago, my mother seems to have spontaneously developed some kind of debilitating condition (she can't go to work). Both her eyes are extremely red, irritated, tearing, with eyedrops being ineffective. It feels like there's sand all over, and unbearably itchy around the eyes and especially eyelids. It's been going on for a week now and today seems to be the worst. 

Initially, I gave her some Quercetin thinking it was allergies, but that didn't do anything. She's sneezing and coughing, but says it's from the eye irritation. Sleeping a lot but no fever or anything else.

I've narrowed it down to conjunctivis or blepharitis, but have trouble telling which is which. She has no insurance and is trying to avoid going to the doctor for now.

I understand you can't diagnose this online, but I'd greatly appreciate an opinion as to the best options we have.

Thanks.


----------



## Nyanpichu

Serenitylala said:


> I have been on this forum for a little while and as a physician, I have been asked medical questions here and there in different threads, so I felt it is high time to open a thread specifically for medical questions. During our hospital or clinic hours, doctors don't have the time to answer questions. I'm a traveling physician so I have some time at night to answer questions.
> 
> 
> 
> *Ask anything you want. *
> 
> 
> 
> 
> _Disclaimer: this thread does not constitute a patient-provider relationship. Many things you should see your own primary care provide for, since they are more familiar with your personal medical conditions, medications, and lab results. Always, always, always discuss everything with your own healthcare provider before trying it.
> 
> Also, Please refrain from using real names here to avoid violating people's medical privacy if asking for someone other than yourself._


Why are some people attracted to people of the same sex while other people are attracted to people of the opposite sex


----------



## Gossip Goat

Sometimes I feel as if my torso was very tense, it gets to the point where its painful. It feels muscular and the best way I can describe it is as if my torso were a building but it has a fragile foundation and structure and its about to collapse. The first time it happened I was under a huge amount of stress, same with the second time, the times after that it happens whenever. I don't know if its also posture related. The only way it feels better is if I relax, lie on my stomach and bend my legs towards my back.

What is dis? halp doctor


----------



## ShadowsRunner

This is a great thread!

Okay, I was wondering if you could do me. 
I'm had health issues my whole life, I am 24 now and while I've made some progress I seem really stuck in life because of all of this. Since I was 13 I started developing weird sleeping issues. I had insomnia and I could not sleep, and/or I had difficulty waking up in the morning which severely impacted my ability to attend school(bad) I can't seem to follow a normal sleep schedule and at times I seem almost nocturnal. There are times where I can seriously not get out of bed in the morning, or wake up at a normal time. 

Sometimes my body will just pick a weird time and I won't be able to wake up before then, despite how much sleep I get. Usually it's the after noon or something. 

I've been told that I just need to do chronology and reverse it, but I've done this multiple times to no avail. Or it helps for a while, but if I stay up too late for one night it puts my body clock all out of whack again. This has really screwed up my life. Most Doctors don't really seem to take me seriously though, or really listen to me. I have been wanting to get a referral to get into a sleep clinic to get a study done but I haven't even been able to find one who will do that for me. 

Some other things...

Almost constant fatigue. I just always feel tired. Like, just really tired, and struggle with mental clarity, as well as memory issues lately. Nothing serious, and it's only my short term memory but I just have difficulty with small tasks. Also my thoughts get kind of jumbled and mixed up and it's hard to think with clarity. I can be pretty sharp sometimes, but other times it's horrible. Also I just generally feel like crap. I also feel depressed and emotionally flat. 

This is really frustrating because it feels like my life is just passing before my eyes. Could this just be depression? I often just get diagnosed as this but I really wonder sometimes. I have tried various medications but honestly nothing has worked for me. They just make me sick and give me f-upped side effects. The last one I tried gave me mild hallucinations and made it almost impossible for me to function. 

I have tried just about everything, there's a couple more things I'm going to try but I really wonder if it'll make a difference. My diet isn't the best and I suck at cooking so I am learning vegetarianism(though I consume some meat) and I have been studying nutrition some and have tried exercise on and off for years to some success. 

I know excercise is supposed to help with depression but I am already in pretty good physical shape I think. I have been told this by physicians so it feels like beating a dead horse sometimes in regards to this. Sure it's good for maintenance but for a solution, really? 

Here are some things that have helped periodically. I have noticed that certain things have on occasion(though not everytime) helped a bit and I wonder if they are related at all.

Though I try to eat well I have noticed some foods have related taken my symptoms away(the depression, fatigue, etc)
For example: steak, Chicken(Though only from certain manufactures for some reason) salads, veggie shakes, large meals, protein shakes. 
I know at times when I ate really well(large full meals on a regular basis; basically three square meals a day) I felt really good energy wise. I just felt overall better. But it's difficult to duplicate this on my own as I don't have the most money to spend on food; or time to be cooking constantly. I have tried managing calories and while it has helped a bit it seems sort of sporadic and it's hard to be to get what my supposed ideal calorie intake is. Which is in the 2,000's apparently(young, semi active male)

Sometimes socializing with people who I get along with helps(hard to find this) and intimacy helps but not completely. 
Exercise has at times helped immensely but doesn't seem to work on a regular basis as does meditation. I have noticed a complete remission at times from these things, but again it's often sporadic and only sometimes. 
But even when I'm doing my best the sleep thing often is the most persist. It by hard is the worst and contributes the most to my depression I think. I know at times it's so bad it makes me feel almost suicidal(because it makes me so isolated) Like agony inducing feelings. I don't know if the sleep thing is being caused by depression and thus creating an endless cycle where I am too depressed to sleep properly and then can't sleep properly because I am depressed or if it's unrelated. 

another thing is I have frequent muscle pain as well. I'll be fine but then randomly my muscles clamp up and I get really sore and stiff. So that's pretty much it, I know it's quite a bit. Sorry.

I am 5'10.5, around 135, male, physically in shape, no other existing medical conditions. 

Thanks.


----------



## ShadowsRunner

Oh, I wanted to say that I've had blood tests done. I had one done pretty recently and nothing ever shows up. 

I only recently found a doctor who actually listens to me so I'm happy in that regard. 
But it's super far away and it's been difficult to get to see her very often. And this has only been like one month ago. Get this, she's the only doctor I've met who's been open to the possibility of me having a sleeping disorder despite suffering 10+ constant years and making my life a living hell.

One doctor told me I'm not fat, so there's no possibility I could have one. Cuz, ONLY FAT PEOPLE GET SLEEPING DISORDERS.

Another thing is a lot of people don't even think I'm depressed. I've always been pretty motivated and stuff and I don't fit the description of the typical depressed person I don't think. It's always felt more physical to me. 

I when I was younger, my nutritious was horrible. I never ate enough and that definitely had a huge effect on me. I used eat so little I almost passed out a couple of times from getting so light-headed. That's when I started focusing on calories and haven't(thank god) have had anything like this happen to me again.


----------



## Serenitylala

Metasentient said:


> Hello,
> 
> This has been a very informative thread, both in terms in medical information from a physician, and understanding the intricacies of the system you come from.
> 
> I have a question ... As of a couple of days ago, my mother seems to have spontaneously developed some kind of debilitating condition (she can't go to work). Both her eyes are extremely red, irritated, tearing, with eyedrops being ineffective. It feels like there's sand all over, and unbearably itchy around the eyes and especially eyelids. It's been going on for a week now and today seems to be the worst.
> 
> Initially, I gave her some Quercetin thinking it was allergies, but that didn't do anything. She's sneezing and coughing, but says it's from the eye irritation. Sleeping a lot but no fever or anything else.
> 
> I've narrowed it down to conjunctivis or blepharitis, but have trouble telling which is which. She has no insurance and is trying to avoid going to the doctor for now.
> 
> I understand you can't diagnose this online, but I'd greatly appreciate an opinion as to the best options we have.
> 
> Thanks.


Unfortunately, you're right. Without seeing her eyes, I'm limited in being able to pinpoint what the problem is. This could be viral, bacterial, or allergic. Is there any discharge from the eyes and if so, what does it look like. Are the eyelids swollen? Are Warm compresses over the eyes ineffective? These are the questions she would be asked, but truth be told, this has been going on for a week. She needs to be seen and most likely needs to have prescription antibiotic eye drops.


----------



## Serenitylala

Nyanpichu said:


> Why are some people attracted to people of the same sex while other people are attracted to people of the opposite sex


Personal preference.


----------



## Serenitylala

Gossip Goat said:


> Sometimes I feel as if my torso was very tense, it gets to the point where its painful. It feels muscular and the best way I can describe it is as if my torso were a building but it has a fragile foundation and structure and its about to collapse. The first time it happened I was under a huge amount of stress, same with the second time, the times after that it happens whenever. I don't know if its also posture related. The only way it feels better is if I relax, lie on my stomach and bend my legs towards my back.
> 
> What is dis? halp doctor


This sounds like a form of panic attacks. Abdominal wall muscles can be very sensitive to stress... As can your intestines. But in this case your abdominal muscles are the ones responding to both mental and physical stressors. Also imbalances in electrolytes (magnesium, calcium, and potassium) can contribute to this condition.

More things can be possible causes, but this is the most common cause.


----------



## Metalize

Serenitylala said:


> Unfortunately, you're right. Without seeing her eyes, I'm limited in being able to pinpoint what the problem is. This could be viral, bacterial, or allergic. Is there any discharge from the eyes and if so, what does it look like. Are the eyelids swollen? Are Warm compresses over the eyes ineffective? These are the questions she would be asked, but truth be told, this has been going on for a week. She needs to be seen and most likely needs to have prescription antibiotic eye drops.


Ah, it figures. 

She doesn't have any colored discharge, just a clear crust in the mornings that she washes off. Yes, terribly swollen skin all around the eyes and lids. The compresses are providing some relief, but she can't take them off without the itching/irritation coming back.

Thanks very much for your help.


----------



## Json221

Can you give a good heuristic for a good diet? I notice there is basically no consensus in the medical community, and perhaps this is caused by lots of diet programs having a stake in their diet considered to be the best. I generally just try to avoid bad stuff (sweets, white grains, very fatty meats, fast food, frozen meals, ...) and try to eat things that seem to have a diversity of nutritional stuff in them. Stuff that has color to it or tastes complex, not processed. Then I just exercise so that I'm at a healthy weight.

This intuitively feels right, but maybe my intuition is wrong and I need to make sure that I don't eat too much tuna because 2 servings of tuna a week is somehow worse for you than 2 big macs a week (extreme example). I notice a lot of people have this concept of "looks/feels healthy" without any empirical evidence to back it up.

Relatedly, do you know why there isn't a standardization of healthy-unhealthy foods, a standardized guaranteed-to-be-healthy diet, or anything along these lines in the medical community? Everything I read is extremely fuzzy. It seems like studying diets is often not coordinated well and the results are scattered and unrelated often - and this leads to the public having little idea on what is healthy/unhealthy other than "I read it somewhere/heard it from a friend."

Oh, and your thoughts on Soylent?


I realize you're not a dietician, just thought you might be familiar.


----------



## Serenitylala

CloudySkies said:


> This is a great thread!
> 
> Okay, I was wondering if you could do me.
> I'm had health issues my whole life, I am 24 now and while I've made some progress I seem really stuck in life because of all of this. Since I was 13 I started developing weird sleeping issues. I had insomnia and I could not sleep, and/or I had difficulty waking up in the morning which severely impacted my ability to attend school(bad) I can't seem to follow a normal sleep schedule and at times I seem almost nocturnal. There are times where I can seriously not get out of bed in the morning, or wake up at a normal time.
> 
> Sometimes my body will just pick a weird time and I won't be able to wake up before then, despite how much sleep I get. Usually it's the after noon or something.
> 
> I've been told that I just need to do chronology and reverse it, but I've done this multiple times to no avail. Or it helps for a while, but if I stay up too late for one night it puts my body clock all out of whack again. This has really screwed up my life. Most Doctors don't really seem to take me seriously though, or really listen to me. I have been wanting to get a referral to get into a sleep clinic to get a study done but I haven't even been able to find one who will do that for me.
> 
> Some other things...
> 
> Almost constant fatigue. I just always feel tired. Like, just really tired, and struggle with mental clarity, as well as memory issues lately. Nothing serious, and it's only my short term memory but I just have difficulty with small tasks. Also my thoughts get kind of jumbled and mixed up and it's hard to think with clarity. I can be pretty sharp sometimes, but other times it's horrible. Also I just generally feel like crap. I also feel depressed and emotionally flat.
> 
> This is really frustrating because it feels like my life is just passing before my eyes. Could this just be depression? I often just get diagnosed as this but I really wonder sometimes. I have tried various medications but honestly nothing has worked for me. They just make me sick and give me f-upped side effects. The last one I tried gave me mild hallucinations and made it almost impossible for me to function.
> 
> I have tried just about everything, there's a couple more things I'm going to try but I really wonder if it'll make a difference. My diet isn't the best and I suck at cooking so I am learning vegetarianism(though I consume some meat) and I have been studying nutrition some and have tried exercise on and off for years to some success.
> 
> I know excercise is supposed to help with depression but I am already in pretty good physical shape I think. I have been told this by physicians so it feels like beating a dead horse sometimes in regards to this. Sure it's good for maintenance but for a solution, really?
> 
> Here are some things that have helped periodically. I have noticed that certain things have on occasion(though not everytime) helped a bit and I wonder if they are related at all.
> 
> Though I try to eat well I have noticed some foods have related taken my symptoms away(the depression, fatigue, etc)
> For example: steak, Chicken(Though only from certain manufactures for some reason) salads, veggie shakes, large meals, protein shakes.
> I know at times when I ate really well(large full meals on a regular basis; basically three square meals a day) I felt really good energy wise. I just felt overall better. But it's difficult to duplicate this on my own as I don't have the most money to spend on food; or time to be cooking constantly. I have tried managing calories and while it has helped a bit it seems sort of sporadic and it's hard to be to get what my supposed ideal calorie intake is. Which is in the 2,000's apparently(young, semi active male)
> 
> Sometimes socializing with people who I get along with helps(hard to find this) and intimacy helps but not completely.
> Exercise has at times helped immensely but doesn't seem to work on a regular basis as does meditation. I have noticed a complete remission at times from these things, but again it's often sporadic and only sometimes.
> But even when I'm doing my best the sleep thing often is the most persist. It by hard is the worst and contributes the most to my depression I think. I know at times it's so bad it makes me feel almost suicidal(because it makes me so isolated) Like agony inducing feelings. I don't know if the sleep thing is being caused by depression and thus creating an endless cycle where I am too depressed to sleep properly and then can't sleep properly because I am depressed or if it's unrelated.
> 
> another thing is I have frequent muscle pain as well. I'll be fine but then randomly my muscles clamp up and I get really sore and stiff. So that's pretty much it, I know it's quite a bit. Sorry.
> 
> I am 5'10.5, around 135, male, physically in shape, no other existing medical conditions.
> 
> Thanks.


The sleep-wake cycle is highly correlated with depression. And you are right, depression markedly affects a person's energy level as well as contributes to a person's inability to sleep. And you are even more correct that eating-right affects this as well.

There is a lot more going on with your condition that meets the eye. Do you have any of your recent lab results on hand? Not all doctors read lab results the same. 

And yes, you do have a sleeping disorder, fat or not, you do have one.


----------



## ShadowsRunner

Serenitylala said:


> The sleep-wake cycle is highly correlated with depression. And you are right, depression markedly affects a person's energy level as well as contributes to a person's inability to sleep. And you are even more correct that eating-right affects this as well.
> 
> There is a lot more going on with your condition that meets the eye. Do you have any of your recent lab results on hand? Not all doctors read lab results the same.
> 
> And yes, you do have a sleeping disorder, fat or not, you do have one.


No. They've never even mentioned anything like this to me. They just take my blood and then scan it I guess and tell me it's fine afterwards. But I've heard there's different kinds of blood tests but I don't know if that's true or not. 

again I feel like my experience with doctors have not been very positive. Usually when I ask questions like that they cut me off, and get angry at me or something. It's weird. It seems like they just want to fit me into some mental health criteria and then force medication down my throat even when I tell them they make me sick. I've heard there are different levels too when your blood test results come back. Is that true? like, you can test in the normal range for something, but it can still be too low.

As for sleeping disorders, for it to be considered that, or at least from you saying I do, does it have to be neurological? Could it be caused by something else? I agree, I mostly obviously do as everything stands but I just wonder if/ how reversible it could be.


----------



## Serenitylala

Json221 said:


> Can you give a good heuristic for a good diet? I notice there is basically no consensus in the medical community, and perhaps this is caused by lots of diet programs having a stake in their diet considered to be the best. I generally just try to avoid bad stuff (sweets, white grains, very fatty meats, fast food, frozen meals, ...) and try to eat things that seem to have a diversity of nutritional stuff in them. Stuff that has color to it or tastes complex, not processed. Then I just exercise so that I'm at a healthy weight.
> 
> This intuitively feels right, but maybe my intuition is wrong and I need to make sure that I don't eat too much tuna because 2 servings of tuna a week is somehow worse for you than 2 big macs a week (extreme example). I notice a lot of people have this concept of "looks/feels healthy" without any empirical evidence to back it up.
> 
> Relatedly, do you know why there isn't a standardization of healthy-unhealthy foods, a standardized guaranteed-to-be-healthy diet, or anything along these lines in the medical community? Everything I read is extremely fuzzy. It seems like studying diets is often not coordinated well and the results are scattered and unrelated often - and this leads to the public having little idea on what is healthy/unhealthy other than "I read it somewhere/heard it from a friend."
> 
> Oh, and your thoughts on Soylent?
> 
> 
> I realize you're not a dietician, just thought you might be familiar.


A good diet should be based on your genetically needs as well as correlate to the times during the day that your insulin levels increase and decrease within your body.

Also the type of diet advised should depend on what you want to accomplish: Body building, weight-loss, maintenance, treating an illness... Etc. tell me exactly what your goals are and I will give you an appropriate heuristic to meet them.

If you're interested in a more detailed approach:
The best book to read on realistic nutritional diets is "what does your doctor look like naked" by dr. Warren Willey.


----------



## Serenitylala

CloudySkies said:


> No. They've never even mentioned anything like this to me. They just take my blood and then scan it I guess and tell me it's fine afterwards. But I've heard there's different kinds of blood tests but I don't know if that's true or not.
> 
> again I feel like my experience with doctors have been very positive. Usually when I ask questions like that they cut me off, and get angry at me or something. It's weird. It seems like they just want to fit me into some mental health criteria and then force medication down my throat even when I tell them they make me sick. I've heard there are different levels too when your blood test results come back. Is that true? like, you can test in the normal range for something, but it can still be too low.
> 
> As for sleeping disorders, for it to be considered that, or at least from you saying I do, does it have to be neurological? Could it be caused by something else? I agree, I mostly obviously do as everything stands but I just wonder if/ how reversible it could be.


As for results being within normal lab values and still being too low... Oh yeah, that happens all the time. for instance, with thyroid hormones: the reference range is up to 4 for the TSH, but anything above 2 is actually indicative of hypothyroidism.

As for the doctors that keep acting like that with you... That is typical of the field. I have to deal with them all the time and I can't stand it as their colleague, I can imagine how their patients must feel.

Back to you:
What you need is a full health diagnostic laboratory panel.... Which is a four page comprehensive laboratory panel. With testing for a mutation in the MTHFr gene... Yes, you read it right, the gene is called MTHFr , or in other words, “methylenetetrahydrofolate reductase (NAD(P)H).”
MTHFr is associated with depression, eating disorders, and sleep disorders.


----------



## Jojo17

Maybe you've said this somewhere and I missed it, but what kind of doctor are you? Why did you choose this specialty?

What are the benefits to becoming a physician instead of a PA?

What kind of clinical experience did you get back when you were a pre-med preparing to apply to med schools?

If you could go back and do it again, would you choose this career? Would you discourage you children from seeking this career?

Thanks.


----------



## Json221

Serenitylala said:


> A good diet should be based on your genetically needs as well as correlate to the times during the day that your insulin levels increase and decrease within your body.
> 
> Also the type of diet advised should depend on what you want to accomplish: Body building, weight-loss, maintenance, treating an illness... Etc. tell me exactly what your goals are and I will give you an appropriate heuristic to meet them.
> 
> If you're interested in a more detailed approach:
> The best book to read on realistic nutritional diets is "what does your doctor look like naked" by dr. Warren Willey.


Thanks for the reply. The genetic + time of day stuff explains why we can't have a standardized diet. I still think there can be a roughly standardized diet, though.

I'm 5'8 and 145lbs, 20 years old. I want to do some amount of body building (+10lbs of muscle, -5lbs of fat) and then maintenance from that point onwards. The "maintenance" is also staying healthy such that I minimize health issues in the future. I don't have many unhealthy habits formed (no fast food, no soda, no candy, some coffee) so in your recommendation you can assume above-average ability to stick with the heuristic. Additionally, I do weights twice a week and otherwise do medium intensity cardio (soccer, racquetball, biking, ...) around 2 times, but preferably more.

I was an athlete while growing up and I've pretty much been my weight/form (give or take) ever since I stopped growing. I feel as if I can eat anything and not gain any weight, so I'm just eating as much as possible while making sure it's not bad for me.

Thanks for the book recommendation - and for spending your time here helping people out. It's a very selfless and thoughtful thing to do.


----------



## ShadowsRunner

Serenitylala said:


> As for results being within normal lab values and still being too low... Oh yeah, that happens all the time. for instance, with thyroid hormones: the reference range is up to 4 for the TSH, but anything above 2 is actually indicative of hypothyroidism.
> 
> As for the doctors that keep acting like that with you... That is typical of the field. I have to deal with them all the time and I can't stand it as their colleague, I can imagine how their patients must feel.
> 
> Back to you:
> What you need is a full health diagnostic laboratory panel.... Which is a four page comprehensive laboratory panel. With testing for a mutation in the MTHFr gene... Yes, you read it right, the gene is called MTHFr , or in other words, “methylenetetrahydrofolate reductase (NAD(P)H).”
> MTHFr is associated with depression, eating disorders, and sleep disorders.


ERm, do think there is a high chance I have this MTHFr gene mutation and if so is this fatal? I just looked it up briefly and I am mildly horrified. What I'm seeing is Alzheimer, and various forms of cancer being the main thing.

Not gonna lie. A little freaked out.


----------



## Serenitylala

Jojo17 said:


> Maybe you've said this somewhere and I missed it, but what kind of doctor are you? Why did you choose this specialty?
> 
> What are the benefits to becoming a physician instead of a PA?
> 
> What kind of clinical experience did you get back when you were a pre-med preparing to apply to med schools?
> 
> If you could go back and do it again, would you choose this career? Would you discourage you children from seeking this career?
> 
> Thanks.


I am an internal medicine physician. I actually chose it, because it noted to have a family, otherwise I would have been a cardiovascular surgeon.

PA vs physician.... PA has a lot more advantages in terms of immediacy of being able to practice after medical school. Yet, you always have to have a physician over you. Less school debt though and no need for residency program. But you are looked down upon as a begin stuck in the not-a-nurse-not-a-doctor category.

Pre-med clinical: I shadowed every specialty I could get a spot with, volunteered to help with a medical group at an Air Force base, worked in several labs, became an EmT and volunteered as one, participated in several disaster medicine programs, etc.

If I could go back.... I'd absolutely go into medicine, but maybe become a nurse practitioner instead. Less long of a haul and has enough anonymity, PAs are controlled more.


----------



## Serenitylala

CloudySkies said:


> ERm, do think there is a high chance I have this MTHFr gene mutation and if so is this fatal? I just looked it up briefly and I am mildly horrified. What I'm seeing is Alzheimer, and various forms of cancer being the main thing.
> 
> Not gonna lie. A little freaked out.



Let me give you some relief... It is easily treated by a type of vitamin B6 that is created specifically for those with mutations on this gene. It is one of the most easily treated genetical abnormality... The vitamin is expensive seeing as only two companies in the US manufacture it, but it's so simple with the same amount of side effects any vitamin b would have.


----------



## Gossip Goat

Serenitylala said:


> This sounds like a form of panic attacks. Abdominal wall muscles can be very sensitive to stress... As can your intestines. But in this case your abdominal muscles are the ones responding to both mental and physical stressors. Also imbalances in electrolytes (magnesium, calcium, and potassium) can contribute to this condition.
> 
> More things can be possible causes, but this is the most common cause.


Sometimes it comes sporadically, when I'm not under any copious amounts of stress. I'll try consuming stuff to see if its related to electrolytes. Also my sister drank about 8 small cups of water very fast and feels very nauseous and wishes she could vomit but can't? Is there any way to alleviate her nauseousness?


----------



## Serenitylala

Json221 said:


> Thanks for the reply. The genetic + time of day stuff explains why we can't have a standardized diet. I still think there can be a roughly standardized diet, though.
> 
> I'm 5'8 and 145lbs, 20 years old. I want to do some amount of body building (+10lbs of muscle, -5lbs of fat) and then maintenance from that point onwards. The "maintenance" is also staying healthy such that I minimize health issues in the future. I don't have many unhealthy habits formed (no fast food, no soda, no candy, some coffee) so in your recommendation you can assume above-average ability to stick with the heuristic. Additionally, I do weights twice a week and otherwise do medium intensity cardio (soccer, racquetball, biking, ...) around 2 times, but preferably more.
> 
> I was an athlete while growing up and I've pretty much been my weight/form (give or take) ever since I stopped growing. I feel as if I can eat anything and not gain any weight, so I'm just eating as much as possible while making sure it's not bad for me.
> 
> Thanks for the book recommendation - and for spending your time here helping people out. It's a very selfless and thoughtful thing to do.


I'm about to go to sleep, but I want you to know that I am going to answer your question tomorrow if I can. It takes a bit to type up what you will need for a the basic body building diet.

Granted I am unable to give you a complete one because I don't have your lab results, which I would do a gambit of labs on you including your hormone levels and genetical predisposition tests for diabetic genes, etc. but I can give you a start.


----------



## Json221

@Serenitylala Sounds good - if it's too much a hassle for you then a recommendation of what type of person I should go to (dietician, trainer, lab for blood/genetic tests, ....) would be more than enough. I'm totally unaware of who I should go to for my "concerns".

I feel a bit guilty having you write up a whole dietary recommendation for me, is all.


----------



## Red Panda

Metasentient said:


> Ah, it figures.
> 
> She doesn't have any colored discharge, just a clear crust in the mornings that she washes off. Yes, terribly swollen skin all around the eyes and lids. The compresses are providing some relief, but she can't take them off without the itching/irritation coming back.
> 
> Thanks very much for your help.


This reminds me of conjunctivitis that I had last year, my eye would "cry" puss constantly and in the mornings I had to open it slowly as the lids were stuck together. It wasn't swollen, but a bit itchy. If it's the same case for your mother she needs antibiotic drops for sure, they worked very well for me.


----------



## xisnotx

Serenitylala said:


> Excessive masturbation leads to Peyronie's disease (which is a buildup of plaque inside the shaft of the penis), inflammation and scarring of the penile tissue itself, later resulting in erectile dysfunction as well as ejaculatory dysfunction which is a separate issue from erectile dysfunction. Also, there have been studies linking excessive masturbation to early prostate cancer.
> Over masturbation produces a serious drain on the man's hormones, vitamins and minerals (especially zinc) as well as causes the physical trauma to the penis and it's attachments..


Hmm, masturbation seems wrong, then.
I wonder, to what do you attribute the differentiation in masturbation and sex in terms of health costs? Or is there none? Does an over masturbated individual differ in any way to an over sexed individual? What benefit is there to having a woman "around", in both the literal and figurative senses, as a man achieves orgasm? Or are there none? Except babies? Again, in the literal sense?

I will grant you the scaring of penile tissue. Vaginas do seem softer than hands after all, or at least my experience speaks to that. But, the serious drainage of a man's hormones, semen build up, the tendency towards prostate cancer, chronic fatigue, and ejaculatory dysfunction seem concerns independent of a woman's presence, or am I in error?

Answer me this, doc, expediently, it is of primary importance in my life. I may be harming myself without even knowing!


----------



## Red Panda

^

I'd also like to ask what does "excessive masturbation" mean, which are the limits?


----------



## 7rr7s

In your experience, what have been some of the better medications for treating depression and bipolar? Also, I always hear one of the risks is suicidal thoughts in teens and young adults. How significant of a drop is this side affect once one is an adult?


----------



## Tad Cooper

What could be causing seemingly causeless extreme anxiety? Would coming off medication for depression a year ago affect it?


----------



## Serenitylala

vinniebob said:


> thank you and happy new years


Talked with several other specialists, still no answers. I keep getting the "what were his lab results?" From them. One suggested that you see a licensed "chronology healer." 

I'll keep searching for you.


----------



## Serenitylala

Json221 said:


> Thanks for the reply. The genetic + time of day stuff explains why we can't have a standardized diet. I still think there can be a roughly standardized diet, though.
> 
> I'm 5'8 and 145lbs, 20 years old. I want to do some amount of body building (+10lbs of muscle, -5lbs of fat) and then maintenance from that point onwards. The "maintenance" is also staying healthy such that I minimize health issues in the future. I don't have many unhealthy habits formed (no fast food, no soda, no candy, some coffee) so in your recommendation you can assume above-average ability to stick with the heuristic. Additionally, I do weights twice a week and otherwise do medium intensity cardio (soccer, racquetball, biking, ...) around 2 times, but preferably more.
> 
> I was an athlete while growing up and I've pretty much been my weight/form (give or take) ever since I stopped growing. I feel as if I can eat anything and not gain any weight, so I'm just eating as much as possible while making sure it's not bad for me.
> 
> Thanks for the book recommendation - and for spending your time here helping people out. It's a very selfless and thoughtful thing to do.


Usually for your goals and body type the paleo diet on a timed schedule concentrating on micro and macronutrients is the best bet. Personally, I'd like to see your cortisol and testosterone levels, your lipids, your CrP, and apoE before I really give you a diet, but we'll start with the basics.

Insulin is one of the main growth hormones in your body... (For instance people with a genetic propensity towards diabetes mellitus type 2, they are prone to insulin resistance thus increasing the amount of insulin in their bodies and through a series of indirect mechanisms put on fat faster. 

Insulin levels spike in the morning and drop off drastically in the evening. So from a weight loss standpoint, the old Wives tale of eating a big breakfast in the morning and a very small dinner at night, is in a way correct.

But let's take a step further, you eat your fruit and grains in the morning... And no carbohydrates at night... And don't eat for two hours before you go to bed... Which is the hardest time not to eat because you are trying to wind down at the end of the day and it's the time most people get the munchies.

If you eat within two hours of sleep, your body doesn't know what to do with the calories so automatically stores it regardless... And your eating durning those hours spikes insulin when it should be low... Thus causing a slowing of your metabolism. For instance, during sleep when insulin levels haven't been stimulated at inappropriate times, your body is a fat burning machine. Sleep is when your body heals and burns fat naturally without the added help of exercise.

Also, the amount of water you take in per day, granted you don't have any water-prohibitive health conditions like CHF or ESRD, affects your fat burning and muscle building cycle. A good body builder will drink more than two gallons of water a day.

In addition, the yep of foods you eat plays a vital role in addition to when you eat them and how you eat them. 

Let's take the potato. If you're going to eat it, you need to eat colored potatoes such as yams or sweet potatoes or purple or red fingerlings. The white potato has the highest glycemic index. Also, if you must eat the white potato, then eat it cold. Being cold, it decreases the glycemic index, due to the fact that temperature affects how fast the starches in the potato are broken down. Hot speeds up the starches breakdown in your mouth and thus raising the glycemic index in your gastrointestinal system... And your body sees it as Sugar.

So starches, fruits, and carbs ain't the morning. And meats and veggies, saving orange colored veggies, at night. Nothing two hours before bedtime.

This is the basic diet... But the rest depends on your genetics and hormone levels.


----------



## Serenitylala

Gossip Goat said:


> Sometimes it comes sporadically, when I'm not under any copious amounts of stress. I'll try consuming stuff to see if its related to electrolytes. Also my sister drank about 8 small cups of water very fast and feels very nauseous and wishes she could vomit but can't? Is there any way to alleviate her nauseousness?


It is the balance between the electrolytes that is important. Too much calcium decreases the sodium. Too much sodium and glucose, decreases your potassium.

An old wives tale that actually helps because of the rich sodium and magnesium content is drinking dill pickle juice. Personally, I'd rather take supplements and manage my stress levels than drink pickle juice.

As for your sister, not much to do for her, except wait for her bowels to move. She has intestinal stretch induced nausea, usually associated with constipation. If she was in the hospital, we could give her metoclopramide. But it's just a natural reaction to the stretch receptors in her belly having a tizzy fit.


----------



## Serenitylala

Json221 said:


> @Serenitylala Sounds good - if it's too much a hassle for you then a recommendation of what type of person I should go to (dietician, trainer, lab for blood/genetic tests, ....) would be more than enough. I'm totally unaware of who I should go to for my "concerns".
> 
> I feel a bit guilty having you write up a whole dietary recommendation for me, is all.


I really do suggest reading some of dr. Warren Wiley's books: he's one of the top medical specialists on nutritional medicine. Inside his books you will find a series of diets, one of which will work for you. I highly recommend you going to a functional medicine physician that has nutritionists inside their office working with them that is board certified by the American Academy of AntiAging.


----------



## Serenitylala

xisnotx said:


> Hmm, masturbation seems wrong, then.
> I wonder, to what do you attribute the differentiation in masturbation and sex in terms of health costs? Or is there none? Does an over masturbated individual differ in any way to an over sexed individual? What benefit is there to having a woman "around", in both the literal and figurative senses, as a man achieves orgasm? Or are there none? Except babies? Again, in the literal sense?
> 
> I will grant you the scaring of penile tissue. Vaginas do seem softer than hands after all, or at least my experience speaks to that. But, the serious drainage of a man's hormones, semen build up, the tendency towards prostate cancer, chronic fatigue, and ejaculatory dysfunction seem concerns independent of a woman's presence, or am I in error?
> 
> Answer me this, doc, expediently, it is of primary importance in my life. I may be harming myself without even knowing!


*excessive* masturbation is harmful.

Okay, let's back up here. It seems that you have some underlying issues regarding this subject. It appears that you have been through some emotionally harmful relationships in the past. I am an Internal Medicine physician, so I do not specialize in sexual behavior counseling, but I can point you in the direction of psychologists that can assist you in that area.

Masturbation is typically used to relieve sexual tension when one is not in a healthy relationship to avoid the emotional and physical problems that may arise from one-night-stands. 

I can see that your past history with relationships may have left you scarred and bitter. Your arguments are emotionally based, and that too is understandable. When it comes to medicine, scientific studies override emotional debates. Sound scientific studies have proven that excessive masturbation is harmful to men in the areas that I have already stated.

Unless you can produce scientific studies from the New England Journal of Medicine, the Journal of the American Medical Association, the Journal of Urology, etc... Then your reasonings will only remain based in your personal opinions and emotional scars, and unfounded in science and founded only in emotional backlashes for something was debasing what may be a favorite pastime of yours.

I know this sounds harsh, but if you went through the many hazing years of medical school and residency, you would know that what I just told you is what any physician would say in response to your opinions. The first response is: what scientific studies do you base your argument on and what peer-reviewed journals did they come from. All I can say, is welcome to my world. If you can't prove with science what you are saying the you get labeled the fool. But I am not labeling you the fool... 

I believe you have been emotionally hurt and are basically saying that you took the "excessive masturbation is harmful" as "masturbation is wrong." You probably have been rebuffed by many for masturbating, to the point where they appeared to accuse you of deviancy.

For the record, I never made any moral statement about it. Nor did I give my opinion as to whether masturbation was right or wrong. I stated the evidence obtained from studies that indicated excessive masturbation led to health problems.


----------



## Serenitylala

Red Panda said:


> ^
> 
> I'd also like to ask what does "excessive masturbation" mean, which are the limits?


I have seen no studies listing the limits. So this is where science fails. What is considered excessive varies from person to person... Most urologists would say that anything more than two-three times a week is excessive. Others say multiple times a day is excessive. (Multiple times a day that interferes with daily life is called Compulsive Masturbation.) But I still haven't seen anything that proves that either of these are the limit. The "limit" stated by psychiatrists is the same limit as placed on drinking alcohol, it is to the level of deviancy: in other words, does it get in the way of your normal life. Does it cause relationship problems? Does it cause physical harm, such as swelling and inflammation.... Or the following...

According to several studies, masturbation does not produce the health benefits that intercourse has in regards to a man's heart health, blood pressure, prostate health, etc. The difference between ejaculation during sex and during masturbation is actually founded in the way that the body physiologically responds. Even the semen and ejaculate are different when a man masturbators as opposed to when he is engaged in intercourse with a partner. 

Masturbation can cause skin irritation, forcefully bending the erect penis can rupture blood vessels within the penis (layperson term for this is penile fracture, even though there is no bone within the structure), or can make the penis turn purple and swollen.

So in a nutshell, no pun intended, there is no set "number of times" limit on masturbation... It is a symptom-based limit.


----------



## Serenitylala

KindOfBlue06 said:


> In your experience, what have been some of the better medications for treating depression and bipolar? Also, I always hear one of the risks is suicidal thoughts in teens and young adults. How significant of a drop is this side affect once one is an adult?


The biggest problem that practitioners have had with diagnosing bipolar disorder both type I and type II, is mistaking it for major depressive disorder and giving just straightforward antidepressants... This then swings the bipolarism sufferer into the manic side of things where they are more likely to commit suicide.

A major study published in the British Journal of Medicine linked antidepressants such as Prozac to an increase in teen suicide among depressed teens and young adults. But these attempts were actually linked to overdosing on the antidepressants which caused pseudo-manic states.

During manic attacks, patients are five times more likely to commit suicide than during depression.

In bipolarism patients, if diagnosed appropriately, they would be placed instead on mood stabilizers such as lithium, and anticonvulsants that stabilize moods such as valproic acid (depakote) and Lamotrigine (Lamictal).

Lithium is the best for managing bipolar disorder, but has the worst side effects. It can affect your kidneys, thyroid, muscles, joints, etc. it is more commonly used in Bipolar Type I, where manic attacks are prevalent.

Valproic acid increases the level of testosterone so it should never be used in young women, it would lead to a condition called drug-induced polycystic ovarian syndrome leading to abnormal menses, and male pattern hair growth.

Lamictal is generally used for bipolar type II, which has more of a depression component. Some patients can develop a serious rash syndrome called Steven-Johnson syndrome. 

There are a variety of other drugs used, including atypical antipsychotics.

I'm not exactly sure which is the best treatment. This is an area of expertise for Psychiatrists. I just deal with the side effects when the patients on these drugs present in my hospitals.


----------



## Serenitylala

tine said:


> What could be causing seemingly causeless extreme anxiety? Would coming off medication for depression a year ago affect it?


If you came off the antidepressant a year ago, it is unlikely that that would contribute to this anxiety attack. Many times anxiety attacks can occur for no reason. Also, patients that have had major depressive disorder are predisposed to having randomly occurring anxiety attacks. 

Sometimes, you may have an isolated anxiety attack without ever having an anxiety disorder. If this occurs again, then you many have a paradoxical form of anxiety, and I recommend you seeing your primary care provider or a psychiatrist for the appropriate treatment. Having anxiety is very common among people with a past history of major depressive disorder.


----------



## 7rr7s

Serenitylala said:


> The biggest problem that practitioners have had with diagnosing bipolar disorder both type I and type II, is mistaking it for major depressive disorder and giving just straightforward antidepressants... This then swings the bipolarism sufferer into the manic side of things where they are more likely to commit suicide.
> 
> A major study published in the British Journal of Medicine linked antidepressants such as Prozac to an increase in teen suicide among depressed teens and young adults. But these attempts were actually linked to overdosing on the antidepressants which caused pseudo-manic states.
> 
> During manic attacks, patients are five times more likely to commit suicide than during depression.
> 
> In bipolarism patients, if diagnosed appropriately, they would be placed instead on mood stabilizers such as lithium, and anticonvulsants that stabilize moods such as valproic acid (depakote) and Lamotrigine (Lamictal).
> 
> Lithium is the best for managing bipolar disorder, but has the worst side effects. It can affect your kidneys, thyroid, muscles, joints, etc. it is more commonly used in Bipolar Type I, where manic attacks are prevalent.
> 
> Valproic acid increases the level of testosterone so it should never be used in young women, it would lead to a condition called drug-induced polycystic ovarian syndrome leading to abnormal menses, and male pattern hair growth.
> 
> Lamictal is generally used for bipolar type II, which has more of a depression component. Some patients can develop a serious rash syndrome called Steven-Johnson syndrome.
> 
> There are a variety of other drugs used, including atypical antipsychotics.
> 
> I'm not exactly sure which is the best treatment. This is an area of expertise for Psychiatrists. I just deal with the side effects when the patients on these drugs present in my hospitals.


That was helpful, thanks. I was on Prozac once and it did make me suicidal and my research found the same thing that you said. Thanks again.


----------



## Serenitylala

KindOfBlue06 said:


> That was helpful, thanks. I was on Prozac once and it did make me suicidal and my research found the same thing that you said. Thanks again.


Prozac can be very rough on people. I'm sorry that you had that experience.


----------



## Kazoo The Kid

When I was about 13 I brushed my tongue too hard and right down the middle it bled for a little bit. Now whenever I extend it, it twitches. It does a sort of "wave" thing and whenever I go to my Doctor they are completely indifferent. They dont even attempt to find out whats wrong and its really annoying and I'm still have pains in my tongue in one area and have had it for years.

Would you have any idea why this happened? Or what to do about my twitchy tongue. Its incredibly annoying, despite its harmlessness.

Also I noticed whenever I eat alot of sugar I get a pain in my leg. What could that even be?


----------



## Serenitylala

Kazoo said:


> When I was about 13 I brushed my tongue too hard and right down the middle it bled for a little bit. Now whenever I extend it, it twitches. It does a sort of "wave" thing and whenever I go to my Doctor they are completely indifferent. They dont even attempt to find out whats wrong and its really annoying and I'm still have pains in my tongue in one area and have had it for years.
> 
> Would you have any idea why this happened? Or what to do about my twitchy tongue. Its incredibly annoying, despite its harmlessness.
> 
> Also I noticed whenever I eat alot of sugar I get a pain in my leg. What could that even be?



Tongue twitching: do you have any other symptoms? Any muscle weakness?

If it is isolated and you have no muscle weaknesses, it is a condition referred to as benign fasciculation syndrome which can occur in any muscle in the body including the tongue. The pain in your tongue most likely is the pain that occurs in an area where there is an old scar, which is an irritating numbing type pain that sometimes can be like an electrical shooting feeling.

The pain in your leg: have you had your blood sugar level and hemoglobin A1C checked?


----------



## Kazoo The Kid

Serenitylala said:


> Tongue twitching: do you have any other symptoms? Any muscle weakness?
> 
> If it is isolated and you have no muscle weaknesses, it is a condition referred to as benign fasciculation syndrome which can occur in any muscle in the body including the tongue. The pain in your tongue most likely is the pain that occurs in an area where there is an old scar, which is an irritating numbing type pain that sometimes can be like an electrical shooting feeling.
> 
> The pain in your leg: have you had your blood sugar level and hemoglobin A1C checked?


I'm not sure if I have muscle weakness. I usually feel like I do but thats probably because I'm miserable and don't get enough sleep along with the fact I'm extremely thin and not muscular. Is that something I should be concerned about?

I had my blood taken about a month ago. My doctor said she would call if there were any anamolies or problems but I guess I should check or ask. But I remember my last blood sugar levels about a year ago were somewhere a little below average.

Also is there a reason sunlight makes my body extremely itchy? Even in the winter standing in the song too long just makes me want to scratch everywhere.

Thannks for my answering my qeustions this is actually very neat because I always immediately forget when I see my Doctor.


----------



## Serenitylala

Kazoo said:


> I'm not sure if I have muscle weakness. I usually feel like I do but thats probably because I'm miserable and don't get enough sleep along with the fact I'm extremely thin and not muscular. Is that something I should be concerned about?
> 
> I had my blood taken about a month ago. My doctor said she would call if there were any anamolies or problems but I guess I should check or ask. But I remember my last blood sugar levels about a year ago were somewhere a little below average.
> 
> Also is there a reason sunlight makes my body extremely itchy? Even in the winter standing in the song too long just makes me want to scratch everywhere.
> 
> Thannks for my answering my qeustions this is actually very neat because I always immediately forget when I see my Doctor.


If you were experiencing the weakness that I was thinking of, you would definitely know it. So no, you have nothing in that area to be concerned about.

As for the itching in response to the sun... There are several things that could cause this. You have no problems with your urine? Any blisters on exposed areas of skin? Any other symptoms? Rashes? Redness in any areas that is abnormal?


----------



## Kazoo The Kid

Serenitylala said:


> If you were experiencing the weakness that I was thinking of, you would definitely know it. So no, you have nothing in that area to be concerned about.
> 
> As for the itching in response to the sun... There are several things that could cause this. You have no problems with your urine? Any blisters on exposed areas of skin? Any other symptoms? Rashes? Redness in any areas that is abnormal?


Absolutely none of that. Its just uncontrollable itching everywhere.


----------



## Serenitylala

Kazoo said:


> Absolutely none of that. Its just uncontrollable itching everywhere.


Sounds like a mild version of a sun allergy... Or otherwise photosensitivity. It's benign in your case, others with more severe cases have polymorphic light eruption and break out into a rash.

As if you hadn't already guessed it, you probably should avoid sunlight, but you do not have a severe enough version of photosensitivity to warrant blacking out your windows or living on a nocturnal schedule.


----------



## Peripheral

Doc, if I hold my right arm straight out to the side palm down, I get a pain in my shoulder. If I'm kind of relaxed, I may or may not feel anything. Is this a sprained muscle, damaged tendon, etc?

P.S - I also used to get a burning/numbness in what I guess is my right lat too. It has mostly disappeared, but I noticed that it came back at little after I posted this. It seemed to be over a larger part of the muscle, now it's just a point. Is this linked to the shoulder issue?

It's been this way for months and I haven't been able to get it checked. Who would I go to to have it looked at?


----------



## Tad Cooper

Serenitylala said:


> If you came off the antidepressant a year ago, it is unlikely that that would contribute to this anxiety attack. Many times anxiety attacks can occur for no reason. Also, patients that have had major depressive disorder are predisposed to having randomly occurring anxiety attacks.
> 
> Sometimes, you may have an isolated anxiety attack without ever having an anxiety disorder. If this occurs again, then you many have a paradoxical form of anxiety, and I recommend you seeing your primary care provider or a psychiatrist for the appropriate treatment. Having anxiety is very common among people with a past history of major depressive disorder.


Thanks for the reply. I was also wondering if you can experience mania without being bipolar or if you can stop being bipolar because of taking medication previously? (I was diagnosed with it and then it seemed to go and then I got mania last night really badly).


----------



## the_natrix

Will pink eye go away on its own? How long would that take?


----------



## Slagasauras

Ah, you seem so busy with this. You are a true doctor.
Anyways, I have cycles of not sleeping (usually fall asleep at two, three, or four in the morning) which lasts from two to three weeks. I'm going through one right now and my friend thinks I should see my primary care provider, but I sometimes wonder if he would give me a prescription for something that I don't need of course.
Oh I should mention I had a blood test done a couple of weeks ago and nothing was out of the ordinary.


----------



## Serenitylala

tine said:


> Thanks for the reply. I was also wondering if you can experience mania without being bipolar or if you can stop being bipolar because of taking medication previously? (I was diagnosed with it and then it seemed to go and then I got mania last night really badly).


There are many types of bipolar disorder, some of which are rapid cycles, others have less manic states called hypomania, others have one or two manic states...

Having only one manic attack clarifies you as a bipolar type I. Overdosing on antidepressants can simulate a pseudo manic state but you get diarrhea and red skin with it.

Real manic states will happen outside of this though sunlight, antidepressants (non-bipolar antidepressants), among other things can spark them.

So what you have is bipolar type I.


----------



## Serenitylala

the_natrix said:


> Will pink eye go away on its own? How long would that take?


It can... Not likely, but the body is designed to fight off infections. I'd get antibiotics because, you don't want to mess with your eyes. You've only got two and they are irreplacable.


----------



## ai.tran.75

What's your thoughts on extended breastfeeding? I breastfed my first child for 2 years(he eats normally and drink milk as well ) it seemed to upset my in laws saying that it'll cause cavity problems( my son has been drinking out of a cup since 9 months old). Is it true? 


Sent from my iPhone using Tapatalk


----------



## Serenitylala

Peripheral said:


> Doc, if I hold my right arm straight out to the side palm down, I get a pain in my shoulder. If I'm kind of relaxed, I may or may not feel anything. Is this a sprained muscle, damaged tendon, etc?
> 
> P.S - I also used to get a burning/numbness in what I guess is my right lat too. It has mostly disappeared, but I noticed that it came back at little after I posted this. It seemed to be over a larger part of the muscle, now it's just a point. Is this linked to the shoulder issue?
> 
> It's been this way for months and I haven't been able to get it checked. Who would I go to to have it looked at?


Truthfully, I would have to physically examine you in order to make a correct diagnosis and put you through a series of passive and active range of motion as well as having to palmate the area. 

I would highly recommend a DO that is a family practitioner with osteopathic manipulation skills, or a neuromuscular specialist whom is also a DO. Don't go to an MD for this or all you'll end up with is a bottle of pills. The DO physicians will put it back into place if the bones are subluxated, or will work on the muscles, etc.


----------



## the_natrix

Serenitylala said:


> It can... Not likely, but the body is designed to fight off infections. I'd get antibiotics because, you don't want to mess with your eyes. You've only got two and they are irreplacable.


Ok, how do you tell if it's a viral or bacterial infection? And does the stuff they usually give work for viral infections?


----------



## Serenitylala

ai.tran.75 said:


> What's your thoughts on extended breastfeeding? I breastfed my first child for 2 years(he eats normally and drink milk as well ) it seemed to upset my in laws saying that it'll cause cavity problems( my son has been drinking out of a cup since 9 months old). Is it true?
> 
> 
> Sent from my iPhone using Tapatalk


No, there is nothing wrong with breast feeding a child until 2 years old. The Leche league have proven that there are no developmental or physical adverse affects from breast feeding up to two. There are hints that breast feeding after the age of two will result in emotional problems for the child, but nothing is conclusive.

But at most hospitals breastfeeding is encouraged up to 1 year because of the health benefits to both mother and child. Between one and two years old, it's not discouraged nor is it HIGHLY recommended like it is for the first year of life. There is nothing against it.

As long as the child drinks out of a cup and has a variety of foods after 9 to 10 months, then your son should be fine. Cavities are not caused by breast feeding, they are caused by lack of brushing a child's teeth.


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## Tad Cooper

Serenitylala said:


> There are many types of bipolar disorder, some of which are rapid cycles, others have less manic states called hypomania, others have one or two manic states...
> 
> Having only one manic attack clarifies you as a bipolar type I. Overdosing on antidepressants can simulate a pseudo manic state but you get diarrhea and red skin with it.
> 
> Real manic states will happen outside of this though sunlight, antidepressants (non-bipolar antidepressants), among other things can spark them.
> 
> So what you have is bipolar type I.


Thanks again for the reply. Yeah I was hoping it might have gone (apparently treatment can rebalance the chemicals that have gone abnormal). 
Bit of a random question, but what's it like being a doctor?


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## ai.tran.75

Double post


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## Serenitylala

the_natrix said:


> Ok, how do you tell if it's a viral or bacterial infection? And does the stuff they usually give work for viral infections?


Usually bacterial gets worse overtime and has thick discharge. Typically bacterial affects one eye but then the patient touches the other eye after touching the infected one and it spreads.

Viral gets better in 7-14 days, affecting both eyes but has no discharge.

Some eye infections can start out viral and then get a secondary bacterial infection.

As for treatments for viral infections, they typically provide symptomatic relief and protect the eye from further damage. It depends on the medication as to by what mechanism they work.


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## Serenitylala

tine said:


> Thanks again for the reply. Yeah I was hoping it might have gone (apparently treatment can rebalance the chemicals that have gone abnormal).
> Bit of a random question, but what's it like being a doctor?


I love the patients, and I love helping people. It's hard sometimes to be around the academic side of medicine because everyone is after everyone else's throats. And the politics is killer... I've watched amazing and well loved doctors get thrust out of hospitals and communities because a single other doctor hated them and wanted their career destroyed.

It's hard work, but worth it.


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## Razef

I've been looking into it but I it seems rater controversial so I'll ask if you don't mind.

Is popping joints actually harmful? I've done it for a long time but I don't feel any different. And why does it seem to be so addictive?


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## petite libellule

How would you treat plantar fasciitis ? tennis elbow? And TMJ? The last one, anything and everything you can say about tmj would be mucho appreciated!!! Thank you!! :kitteh:


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## Serenitylala

ningsta kitty said:


> How would you treat plantar fasciitis ? tennis elbow? And TMJ? The last one, anything and everything you can say about tmj would be mucho appreciated!!! Thank you!! :kitteh:


Plantar fasciitis is actually treatable by taking your thumbs and massaging the sole of your foot as though you are pulling apart the fascia. Tennis elbow can be treated with rest and a placing a wrap around your forearm a few finger widths below your elbows. 

TMJ: usually caused by grinding your teeth at night or if you had your wisdom teeth removed under anesthesia in your youth.

TMJ problems can be treated by osteopathic manipulative treatment by a licensed DO physician. It has to be treated by hands on techniques.


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## petite libellule

Serenitylala said:


> Plantar fasciitis is actually treatable by taking your thumbs and massaging the sole of your foot as though you are pulling apart the fascia. Tennis elbow can be treated with rest and a placing a wrap around your forearm a few finger widths below your elbows.
> 
> TMJ: usually caused by grinding your teeth at night or if you had your wisdom teeth removed under anesthesia in your youth.
> 
> TMJ problems can be treated by osteopathic manipulative treatment by a licensed DO physician. It has to be treated by hands on techniques.


K. Massage therapist here. Was just curious what you would do for the first two conditions that might differ from me. The tmj thing, can you elaborate ? Is there anything I can do aside from neuromuscular treatment ? Also. I have tmj myself and had my wisdom teeth surgically removed when put under .. I never knew that was a precursor .. Any info on tmj (or links/resources) would be enormously appreciated !!! <3 <3 <3


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## Ben8

When women squirt, is it urine.


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## Lexicon Devil

I was wondering the same thing as @Ben8. What is your professional opinion on female ejaculation?
http://personalitycafe.com/sex-relationships/436930-female-ejaculation-comes-two-forms-scientists-find-2.html#post13970658


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## Herp

I don't know if it has been asked but are antidepressants a lifelong treatment? If not, how is the weaning made?


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## Serenitylala

ningsta kitty said:


> K. Massage therapist here. Was just curious what you would do for the first two conditions that might differ from me. The tmj thing, can you elaborate ? Is there anything I can do aside from neuromuscular treatment ? Also. I have tmj myself and had my wisdom teeth surgically removed when put under .. I never knew that was a precursor .. Any info on tmj (or links/resources) would be enormously appreciated !!! <3 <3 <3


Wheel there is a difference between what you can do at home, and what a licensed physician can do. I gave you suggestions for what you can do yourself. Medical treatments include prescriptions, orthotics and injections. 

As for TMJ problems, the following sites will explain things:

Temporomandibular Joint Disorders (TMJ, TMD): Symptoms, Treatment and More

TMJ disorders Treatments and drugs - Diseases and Conditions - Mayo Clinic

TMD TREATMENTS | TMJ.org


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## Serenitylala

Ben8 said:


> When women squirt, is it urine.


Squirt? You're going to have to be more specific as to what you want to know about.


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## Serenitylala

Jeff Felis said:


> I was wondering the same thing as @Ben8. What is your professional opinion on female ejaculation?
> http://personalitycafe.com/sex-relationships/436930-female-ejaculation-comes-two-forms-scientists-find-2.html#post13970658


Honestly, the word ejaculation refers to the fluid excreted by a man's prostate along with his semen that is created within his testes.

Women don't have either of those organs... Women can have an increase in discharge which is designed to lubricate the vaginal area in preparation for intercourse. 

Truthfully, I have never heard of female ejaculation before your question, but I am not an obstetrician so this is out of my area of expertise. It was never discussed in medical school and was never mentioned in any medical books that I know of. Although Skenes glands are referred to in medical literature, there are no references to "female ejaculation."


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## Serenitylala

Herp said:


> I don't know if it has been asked but are antidepressants a lifelong treatment? If not, how is the weaning made?


 For some people it can be a lifelong treatment, for others it is only temporary.

The weaning process depends on the particular antidepressant because of their individual half-lives (or how long it takes for your body to metabolize the drug).

The following is a link to a table from Harvard breaking down the weaning process of particular antidepressants:

How to taper off your antidepressant - Harvard Health Publications


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## ai.tran.75

Have you ever delivered babies - what's your pov on epidural ? Is it safe or are there minor side affect . 

What about homeopathy ? What's your pov on it ? 


Sent from my iPhone using Tapatalk


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## Serenitylala

ai.tran.75 said:


> Have you ever delivered babies - what's your pov on epidural ? Is it safe or are there minor side affect .
> 
> What about homeopathy ? What's your pov on it ?
> 
> 
> Sent from my iPhone using Tapatalk


I have delivered over 100 babies. I quit counting once I went into internal medicine. 

I've seen both the pros and cons of epidurals. Women that get them, are for the most part relieved. They don't have that postpartum rush of endorphins that women of natural childbirth get, so they are more susceptible to postpartum depression.

The most common side effects are a post-epidural headache, anxiety, changes in blood pressure, flushing, fever, and that it only anesthetizes one side of the woman's body instead of providing complete pain relief.

The women that get epidurals, for the most part, don't experience much pain and express how much happier they are with one.

Women experiencing natural birth become so sensitive that cervical ripening checks cause them excruciating pain.

As for homeopathy. I believe it works. Vaccinations are based upon the same principle: introducing a minuscule and controlled sample of the virus, allergen, or similar chemical, produces a physiological response by the body which results in either an increase in immunity or a healing effect.

I believe that there is some great efficacy to homeopathy when applied correctly.


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## the_natrix

How does the standard anti-histamine diphenhydramine work? Does it reduce production of histamine, or maybe destroy it, what's going on there? Please don't tell me it's one of those drugs they use but don't know how it works.


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## Glassland

Throughout my youth (14-18) I spent most of my days at my computer (and still do), I ate a lot of junkfood and smoked around 20 cigarettes a day from age 16 to 20. 
I weight around 100kg and to this day, I look too young for my age (now 22). 
With 18 I started smoking weed with friends for 2 years, lost 15-20kg. On 6.6.2013 I stopped smoking cigarettes and in autumn that year I started doing sports, started to eat healthy and lost another 5 to 10kg.

Now my weight is around 75kg, I still have a belly, gynecomastia and I still look too young for my age. Most people think me to be between 17 and 20.

I still get pimples (not that many) regularly and my beard growth is not very much, but that is probably from my genetics.
My testosterone levels are normal.

My question is: Is it possible that through extensive sitting, unhealthy eating and drinking, smoking cigarettes and in general an unhealthy lifestyle, my physical puberty was, kind of, postponed?

Thanks


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## Serenitylala

the_natrix said:


> How does the standard anti-histamine diphenhydramine work? Does it reduce production of histamine, or maybe destroy it, what's going on there? Please don't tell me it's one of those drugs they use but don't know how it works.


Diphenhydramine is an ethanolamine class of antihistamine. It works by competing with histamine for binding at the Histamine H1-receptor site. 

So unlike other antihistamines such as Cromolyn and Nedocromil which block the release of histamine, diphenhydramine or Benadryl just prevents histamine from attaching to the Histamine H-1 receptors in the brain, GI tract, smooth muscles, and blood vessels. Histamine is still released in the body, but it is unable to attach to the receptors and cause problems.


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## Serenitylala

Glassland said:


> Throughout my youth (14-18) I spent most of my days at my computer (and still do), I ate a lot of junkfood and smoked around 20 cigarettes a day from age 16 to 20.
> I weight around 100kg and to this day, I look too young for my age (now 22).
> With 18 I started smoking weed with friends for 2 years, lost 15-20kg. On 6.6.2013 I stopped smoking cigarettes and in autumn that year I started doing sports, started to eat healthy and lost another 5 to 10kg.
> 
> Now my weight is around 75kg, I still have a belly, gynecomastia and I still look too young for my age. Most people think me to be between 17 and 20.
> 
> I still get pimples (not that many) regularly and my beard growth is not very much, but that is probably from my genetics.
> My testosterone levels are normal.
> 
> My question is: Is it possible that through extensive sitting, unhealthy eating and drinking, smoking cigarettes and in general an unhealthy lifestyle, my physical puberty was, kind of, postponed?
> 
> Thanks


Well... Those things affect the levels of estrogen in your body, which in turn can produce weight gain and gynecomastia. The combination of high testosterone and high estrogen can contribute to acne, even though on their own they do not completely cause acne.

As for delayed puberty, yes testosterone and estrogen levels can affect it, especially in the setting of early weight gain and marajuana. But without further labs, I wouldn't be able to tell you your exact situation. Also, you could be just one of the lucky ones that has a baby face and may always look younger.


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## Glassland

Serenitylala said:


> Well... Those things affect the levels of estrogen in your body, which in turn can produce weight gain and gynecomastia. The combination of high testosterone and high estrogen can contribute to acne, even though on their own they do not completely cause acne.
> 
> As for delayed puberty, yes testosterone and estrogen levels can affect it, especially in the setting of early weight gain and marajuana. But without further labs, I wouldn't be able to tell you your exact situation. Also, you could be just one of the lucky ones that has a baby face and may always look younger.


Not so much a blessing when you get constantly disrespected as a youngster. 
Thanks though, your answer helped me.


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## Ziggurat

Serenitylala said:


> As for homeopathy. I believe it works. Vaccinations are based upon the same principle: introducing a minuscule and controlled sample of the virus, allergen, or similar chemical, produces a physiological response by the body which results in either an increase in immunity or a healing effect.
> 
> I believe that there is some great efficacy to homeopathy when applied correctly.


Show me the literature, for I care not about your beliefs.


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## Siggy

Hi Serenitylala. First thanks for doing this. This has been very informative

Here is my my question and this is a bit of a rant.

Colonoscopies.

Europe. Standard is no sedation

USA. Demerol or Fentanyl with versed. Complete with nasty side affects and recovery time.Or for high risk patients propofol complete with a  anesthesiologist and monitors hooked up to ya.

Now I need a colonoscopy done and fall into the high risk category , due to vicodin use and that I am a slow metabolizer of the opiates and ( had a DNA test to confirm). I asked the doctor if having it done without it was an option. He said no. Called another doc, the office said no and that no one will do it without it ( perhaps not in my area, but I know that some will )

Now the question.

Why such resistance from the gastros. I have a high tolerance for pain, and from what I have read it really isnt a big deal.

Thanks


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## Red Panda

Dear Sigmund said:


> Hi Serenitylala. First thanks for doing this. This has been very informative
> 
> Here is my my question and this is a bit of a rant.
> 
> Colonoscopies.
> 
> Europe. Standard is no sedation
> 
> USA. Demerol or Fentanyl with versed. Complete with nasty side affects and recovery time.Or for high risk patients propofol complete with a  anesthesiologist and monitors hooked up to ya.
> 
> Now I need a colonoscopy done and fall into the high risk category , due to vicodin use and that I am a slow metabolizer of the opiates and ( had a DNA test to confirm). I asked the doctor if having it done without it was an option. He said no. Called another doc, the office said no and that no one will do it without it ( perhaps not in my area, but I know that some will )
> 
> Now the question.
> 
> Why such resistance from the gastros. I have a high tolerance for pain, and from what I have read it really isnt a big deal.
> 
> Thanks


AFAIK we do use sedation in EU, but usually not total anesthesia. I've been in a colonoscopy and they used sedation because they couldn't do total anesthesia due to his age and condition. Poor guy was awake listening to the surgeon swearing for one hour because they kept failing at catching vestiges of his big polyp. I was half expecting the doctor to ragequit. 
Oh and when my mom did it they used some kind of sedative on her, she slept for a while afterwards.
Hope you find a way to do it.


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## INTJellectual

@Serenitylala

Is it true that apple is a natural food suppressant?

Do you know any other natural food that can suppress appetite?


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## VinnieBob

my question is one of psychological related
in Freudian terms my libido is damned up
lately I have been experiencing minor anxiety and aggression [is kept under control]
in the P.M. I have been jonesin it for deep intellectual conservation, a craving like an addict craves drugs
even though this is ego born it is still a deeply rooted desire that needs to be satisfied 
in the general population I am denied my verbal theories on account of my background 
all my passions are philosophy, ontology, cosmology,mythology, theology, psychology etc
sports and small talk have absolutely no meaning to me and no one wants to hear my interests
I need face to face conservation with some one who understands my thoughts
not on a constant basis but only on occasion 
due to my damned libido my insomnia has returned along with impatience and frustration 
which in my case leads to isolation 
the solution is not a easy one since I have tried to start a ''free thinkers'' type club whence we meet once a week
there are all types of clubs but none exist for the thinking person
besides I am INTJ meaning I am socially challenged


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## Ode to Trees

What kind of supplements and behavioral techniques do you recommend for ADD like symptoms in fibromyalgia.


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## Daniellekk

How much do you earn


----------



## Bassmasterzac

Can you take Clomid and an aromatic-inhibitor at the same time? Will my estradiol levels bounce back after titration? How can I lower my estradiol levels in general?


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## He's a Superhero!

Is it true that 5a DHT inhibitors can stop and reverse balding (men and women) regardless of the stage of balding? If so, what side effects could be expected?

What foods boost 5a DHT, and what foods slow or block 5a DHT?


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## EccentricSiren

This is probably an odd question, but what would cause someone to feel short of breath from laughing and is there any way to get rid of it? I enjoy comedy and am surrounded by some very funny people, so this is kind of a pain.


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## outofplace

@Serenitylala, 

My grandson is 4 months old and for the last couple of months he's developed a rash over 90 percent of his body. It's red, inflammed, sensitive to the touch and leathery. My daughter and son-in-law has tried eczema ointments, oatmeal baths, zinc oxide and lanolin. Their pediatrician finally prescribed hydrocortisone 2.5 but his skin is still showing little improvements. I'm upset that this pediatrician is not at all concerned about my grandson's condition. The only explanation she could offer them is that this sort of thing happens when you live in the desert. We live in Arizona but I'm still not satisfied with that weak explanation. I told my daughter to ask the pediatrician for a referral to a dermatologist because maybe they can get down to the wire as to what is going on with my grandson's skin.

My daughter breastfeeds my grandson, so my question to you is could he be allergic to breastmilk? Should she try formula for a while and see if his condition clears up?


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## Death Persuades

When am I going to die?


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## conscius

Serenitylala said:


> Excessive masturbation can lead to inflammation of the penis, leading to erectile dysfunction and inability to ejaculate. The penis was never really designed to be yanked. So it will develop scar tissue and problematic inflammation.
> 
> 
> Also, there have been studies that link excessive masturbation to prostate cancer,* but in all honesty if you are male and live to be above 80 years old, you most likely will get prostate cancer anyway.*.. Excessive masturbation leads to prostate cancer at a much earlier age.


 That's depressing.


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