UK narrow boats and canals. YouTube figured out I like nerdy people being passionate and interesting about the nerdy things they nerd about. Do you think I’m gonna go on a canal boat tour when I go to England? You’re god damn right I am.

Well shit, I grew one town over from there. Pretty sure that’s right by our cliff diving spot on the Croton Falls Reservoir. I never went in it most kids in highschool knew some “facts” about that mine.

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Fortunately CMS is rethinking the role of primary care and realizing we can save money if we’re able to provide high quality preventive care like we’re supposed to. PCP service payments (RVUs) are up 18% since 2020 which has been a long time coming. Unfortunately physician pay is down vs inflation over the last few decades but thank Christ administration salaries are way, way up over the same timeframe.

Just bought a couple of their 4oz coffees, thanks for the suggestion. The Gera Honey dark roast I have high hopes for since I hate light roasts but I don’t really understand what the fuck they’re taking about on their product pages. All I understood was dark roast so I’ll giveit a shot.

And on the total opposite side from the neo-African coffee roaster you suggested, Harrio has the hipsteriest hipster pictured on the Switch product page. Instantly made me hate the product with absolutely no basis for that opinion. Interesting dichotomy of suggestions, 9/10 would look at again.

Schwab app works for me on Graphene and that’s my main bank/stocks app. I’ve found I don’t really need all my credit card apps or my other bank app. I check once a day if that and just keep a bookmark. It hasn’t been bad at all.

Oof this is definitely wrong. A blood thinner is one of the most important things whether a patient is taking or not. It’s the nurses job to let the doctor know whether the patient is compliant not only for medical reasons but for documentation. That’s outside the argument about profit in healthcare in US, that’s basic medicine. What if that patient falls and hits their head? Do we need to know if they’re on s blood thinner? What if they’re hemoglobin starts dropping? What if they need a procedure? What tif their platelets start dropping? Etc, etc, etc.

Don’t be a dick and not do your job, that makes your coworkers miserable and puts people in danger especially in medicine. I agree with burlit being and issue and chronic understaffing but be an adult and quit or move positions if you don’t like it.

What about the 19yo I saw today, with a BMI of 62, who’s so far stuck in the cycle of self loathing, inactivity, depression, and pleasure seeking behavior that he can’t see a way out let alone start creating himself a new reality? What if I have a drug that I’m pretty confident can help him lose 200lbs? Is it ethical for me to not prescribe it because “he should be able to do it on his own?” How many people do you know who have done that? Out of the hundreds or horribly obese patients I’ve seems, I have tow that have done it with diet and exercise. We have not evolved for a world where 20,000 calories costs $20 and is available 24/7.

I agree we need to be cautious with these drugs since long-term adverse effects aren’t known but the long-term effects of obesity are well documented. I have backed off on pitching these drugs since I learned the companies making them have infiltrated the obesity research community in the US (because of course they did). They’re still an amazing tool in the fight against an obesity epidemic which has many, many different contributing factors li ok e trauma, depression, mental health issues, upbringing, genetics, etc, etc. it’s not as easy as “just don’t eat so much.”

It’s not that CPR doesn’t work, it’s that outcomes after resuscitation usually aren’t great. The study doesn’t disclose ages or neurological outcomes post-rescuscitation so that limits my interpretation but quick rescue and quick CPR is key in those acute, single reason emergencies. That isn’t to say in an emergency situation you shouldn’t try especially since you don’t know that person’s wishes. There are good outcomes but usually for underlying healthy people who had one thing go wrong. Think the athlete who’s heart stops on the field for some reason.

I’ve admitted at least a thousand people into a hospital through the ER and I tell everyone that it’s not like on TV. If you’re older, sick, multiple chronic diseases, don’t take care of yourself, etc. the chances of any kind of quality of life after CPR is limited. Death is terrifying and I understand them wanting to try but it’s just not realistic a lot of the time. We need better deaths in the US and more in-depth end-of-life conversations with our patients. That should be starting in the PCP’s office. Trying to discuss that with a patient in the ER who’s already scared isn’t ideal. I’ve seen patients with do not resuscitate/do not intubate orders on file change their mind when they’re suffocating and panicking then once they’re more stable immediately change their mind back.

Thanks, that looks legit, especially considering they got a Nobel for the process. Red blood cells wouldn’t work though, no genetic material to tell the cell what to do. Skin cells sure but deeper layers before they ditch their nucleus. The bottom layer of your epidermis is already made of stem cells that continuously produce new keratinocytes (skin cells). That’d make sense as a starting point for what they did. I’ve been in medicine for seven years and there have been all kinds of crazy claims made but researchers so I’m always skeptical.

Do you have a link for the paper that describes the process for converting blood into stem cells? Curious how they went about it because making red blood cells into stem cells would be hard since they have no nucleus and no DNA. I googled but couldn’t find anything about how they do it.

That makes sense. I don’t think there’s been a moment like that in the podcast, the DM keeps expectations in check.

I’m a casual D&D fan since my only exposure is from Not Another D&D Podcast but I think it adds to the overall story telling experience. Super charges the lows and highs if it’s a 1 or 20 especially on an important role. Does it break the game? Eh, not that I can tell and I’ve listened to hundreds of hours of the podcast. Though this is my opinion and not based on D&D rules, history, etc.

I also highly recommend Not Another D&D Podcast if you like silly shit mixed with crass humor, some good emotional content, and players fucking with their DM.

Gave Fallout 76 a shot again after trying it early in it’s release and quitting due the travesty it was (also because I was disappointed in Starfield). It’s good now, very similar feel to 4 though with some differences. It’s a Fallout game so not perfect but the feeling of endless possibilities you get when stepping out of the vault for the first time is classic Fallout.

Couple of things it could be:

1. You locked your knees without realizing it, shut down the blood return from your legs, then had a drop in blood pressure due to decreased blood return to your heart causing you to pass out.
2. You took a big hit, expanded your chest, held it, decreased blood flow through your thoracic cavity due to the increased intrathoracic pressure then a blood pressure drop as above.
3. Your vasovagaled yourself somehow (bearing down on a held hit maybe or just due to weed effects) which is increased parasympathetic nervous system tone that drops blood pressure
4. Some weird shit 🤷🏼‍♂️, the body can be odd and changes as we age so maybe you just can’t smoke weed now cause of the earlier mentioned weird shit

I agree with your doc (I’m a family med physician), don’t smoke if all of a sudden you’re passing out.

Fucking not 9lbs that’s for sure. Around 1/2lb usually.

But then you don’t get that cheese that dribbled out and sat on the pan and got crunchy and savory and delicious. Like caramelized cheese.

Good hoodie section for quality stuff made in Canada or the US (I didn’t check them all). Didn’t know about Camber but I’ll probably hey something from them. The work pants are dope too. Just bought some from Epaulet and American Trench and digging them.

Switched a month or two ago. Pretty good, no really complaints, setting up the Google services I need is easy to do. Battery life took a hit but still a full day, some hiccups like one bank app that just doesn’t work. Overall I’m happy with it.

First album I played to celebrate. Also the first album I bought for myself as a 13yo along with Wu-Tang Forever.