The Other Half
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After returning from a Disney World trip, he told me how he spent most of it on the hotel room floor because he 'threw his back out' and had general chest pain. Nothing excruciating, just annoying enough that he wasn't up for hours of walking. His friends told him to go the doctor, but he blew it off and said he was feeling better.
The next day he died in the store, behind the register, before we opened, from a heart attack. He was 36.
Last year I went to an urgent care because of chest and back pain. They sent me on to the ER after an EKG showed an abnormal rhythm. Turns out I hit the rowing machine too hard the day before and had a massive case of indigestion from Mexican food at lunch.
I felt silly, but really everyone that I dealt with was cool about it. I'm lucky enough to have insurance that covered it all, and I'm happy that it wasn't a heart attack.
I don't know if there's a moral to this story, just that... shit, you never know when your day is coming, and I still have a lot to do before it happens.
Make a small home machine that can take an EKG and tell you if everything is fine, or if you should go get checked.
Adjust it to give some false positives, but no false negatives.
Make it cost around $50, and make sure it's fully reusable (i.e. you can borrow one from a friend for a quick check).
If machine learning is not up to the task, then send the EKG to a doctor, I believe they can read them in just seconds (correct me if I'm wrong), so it should not be expensive per-person.
To simplify it, have it connect via bluetooth to a phone, so you don't need to worry about WiFi, or a display. For reliability have it store the last 10 readings, even if not connected, so it should have a start button and indicator lights.
https://www.amazon.com/AliveCor-Kardia-Mobile-Android-device...
Might be a good idea! Just don't stop there and be more ambitious. Kill the heart attack market as much as you can by making this technology widely available to those that need it at no cost. Find different ways to earn something from it...
If there is one thing that has been proven over and over again, it's that the market and health care don't go together in terms of efficiency. I'm not even touching the ethics angle here...
When I hear the n-th iteration of the basic income discussion and the "useless" class, health care strikes me as the area to make a real difference in, much more than "basic income". Because even the "useless" class will find ways to sustain itself, given adequate health.
https://arstechnica.com/science/2016/12/junk-food-cravings-a...
* go see a doctor
* urgently go see a doctor!
No, just put 24-hour machines in malls, then you don't need to delay going to market trying to get it under $50
Twice in my life I've presented at the ER with severe chest pain that I thought was heart-related, twice it turned out to be nothing serious (musculo-skeletal pain in one case, very bad indigestion in another), and both times I felt like a fucking idiot for even just showing up, let alone after being told I just need to eat more fruit and shit more often.
But at no point did anyone in the hospital, from the cleaning staff to the nurses to the doctors to the x-ray technicians to the people at the front desk, ever make me feel unwelcome or that I had wasted their time.
When I apologised to a nurse for taking up space in a bed that should have been put to better use for someone who was actually ill, she sat down next to me for a moment and told me that she would rather I was wrong a thousand times and "wasted" a thousand beds in hospital, than right one time and dead at home because I was trying to avoid embarrassment.
My point being, drawing from the practices of people multiple centuries ago might not be the best thing
Given how much of cognitive behavioral therapy borrows from stoicism in this case I think this assessment is premature. Stoicism like buddhism are great philosophies on how to deal with the world as it is. And to understand that most of the problems we think of are products of our own mind.
Stoicism doesn't do either denial or say its natural. It forces you to reevaluate how you think of the question. For that alone it is worth drawing from.
"" I waited 5 anxious minutes, and then was bought into a room with two doctors, one of whom turned out to be Dr. Sonny Palmer.
Sonny said Georg thought I needed some help, and I’d be checked within a day. I asked if he’d seen the letter with his name on it. He hadn’t. He went and got it.
He came back and said I was going to be operated on in an hour. "" You obviously don't want to be rude when talking with doctors, but you absolutely should be your own advocate. Any time you're dealing with medical choise ask questions, such as "did you notice X" or "did you see the information from other person Y" or "do I have other options here than the plan you outlines?" or "your advice sounds good, but what are complications / side effects in doing this?" In the United States it feels like our attitude is "I go to doctor to get fix for aliment. He prescribes X. Done", and it's never that simple.
Make a fuss.
http://www.dailymail.co.uk/health/article-1373373/Study-show...
We need to adjust healthcare. Way more important than the digital world and social networks.
- unconscious/bleeding - bleeding - everything else
Its not that they assume you have nothing its that if you're conscious, whatever you have can wait.
I agree with your advice, but rare are the doctors that don't bounce what you say until it's really heavy.
When I had my appendix removed, I was on a couple of prescription medications, which I brought with me to the hospital to ensure I got the names correct when I informed the front desk clerk as I was admitted. Two days later my nurses had a hissy fit when they discovered that not only was I on prescription medications (this somehow hadn't been communicated), but that I was also administering them myself (apparently a no-no in the hospital).
Apparently no one talks to each other in hospitals.
During the weeks I was with my dad, at Duke Hospital, I got to see extremely excellent care - because he'd been a transplant patient, they took his medications incredibly seriously. Everything was charted and they were always on top of it. There were arguments about his exercise needs, but mostly between him and the nurses, who exhibited a wide range of bedside manner. I definitely think having an advocate with you at the hospital is critical.
At St. Vincent's, I really dealt with superior nurses. Only one was short with me, and that's mostly because she was asking me a question and my answers were too fru-fru for her; she wanted a number, and all I had was a guess. When I finally guesstimated a number, she went away; never saw her again. Meanwhile another walked me though a large post-heart attack education patiently to make sure I understood everything.
The hospital, I'm sad to say, makes a big difference.
While at the hospital the doctor informs me that quite a lot of people with stomach issues misinterpret them for heart attacks and vice versa, which is the really troubling thing because they think it's their stomach and they die since they neglect to see a doctor. So I ask him, how do you tell whether it's a stomach or a heart issue? You don't, he replies. If you feel anything funny related to your chest go to a hospital.
Yeah, my dad died (11 years ago) of a heart attack while he was thinking he had stomach issues.
These words stuck out to me:
> I was fucking annoyed – I felt like I was just super tired and needed some energy, and energy drinks and caffeine weren’t doing the trick.
He then went on to keynote a conference and live for what seems like at least two more days without seeking medical attention.
I'm a mid 30's man, my family history includes heart disease, my father is stubborn as am I. If some day I felt tired, and constricted, my first thought would not be that maybe my heart is failing, but it probably shouldn't be my last thought.
We cannot achieve our goals or lead projects if we are dead. This close call woke me up to paying attention to my body, and maybe we all can benefit from it.
There are obviously ots of competing factors at work: they have plenty of opportunities to eat healthy, and the discipline that makes them get up at 5am also makes them go for a run at 5:30. Then again two of my bosses had to retire after run-ins with the crystal meth law they themselves passed...
Considering the limits of willpower, I'd rank it Smoking/Exercise/Food/Sleep/Stress.
Wait, what?
Sheesh.
With the principals being able to work 18h days, I think their discipline plays a huge part, as you wrote, and maybe they're outliers who naturally cope with these demands better than the average person. I personally can't sustain 12h days for more than a month.
Holy cow. I didn't realize this was possible. This is a good lesson to all of us not to ignore weird, painful phenomena in our body.
A couple of weeks later I started feeling pain on the left side of my jaw (much like a toothache) at the same time I felt the pain in my forearms. Searching again on the Internet I saw that now it was quite probably a heart problem.
About 48 hours after that, the pain in my arms wasn't letting me concentrate on anything (it wasn't stronger, but it felt different, it made me feel that something was really wrong with my body), that's when I went to the emergency room at the hospital.
My dad did the same thing, one day he had some chest pain that he thought was related to something he ate. Drove a semi truck around for about 6 hours, decided to come home early. He came back to the shop, parked his truck and called my mom and said he had indigestion like he'd never experienced, and they went to the doctor. Turned out to be a full-on heart attack he'd been feeling the last 8 hours.
I guess that's a long way of saying listen to your body. Generally, it's trying to tell you something, and if feels just a little off, get checked out. Could definitely save your life.
Also, heart attacks can present very differently in different people. A large number of people (especially women) have atypical presentations that may not include the classic sub-sternal chest pain, so the symptoms often get ignored or missed.
I had an ischemic stroke at the age of 21 while studying abroad in Prague. Rushed to ER and emergency cutting edge surgery, intra-arterial thrombolysis, ensued. This is a 'test' procedure in many parts of the western world. They went through my groin to get to the blot clot in my brain. Woke up that evening in the ER with pretty much no clue what had happened.
While the quality of the care was pretty good, with the surgeon being spectacular, the language barrier made things a bit difficult for my two weeks stay there after! Not to mention I was hands down to everyone's junior in that section of the hospital I was moved to after the ER ha.
Anyway that's the short version of a story I should probably write down somewhere similar to yours. I'm 24 now and completely healthy =). For all the 'making the world a better place (at a macro level)' that us devs are doing it is a nice reminder that making the world a better place on an individual level is probably still the most impact any of us can have. I don't even know what my doctor's name was! But thank you to all you MDs.
Speak for yourself... I'm just automating peoples jobs and subsequently making them unemployed, lol.
The only problem is my insurance pays 1000$ every time I wear it.
The story includes a lot of things that sound like heart attack symptoms. http://www.mayoclinic.org/diseases-conditions/heart-attack/i...
Guys/gals... If there's any unusual pain in your chest cavity at all, just drop whatever it is you're doing and get it checked out. It might not even seem that bad at the time... it didn't to me and it didn't to Jason Scott... just do it.
I almost learned this the hard way a few years ago. I was in my late 30s, and handled going to the doctor the way I always had since reaching adulthood -- which is to say, I didn't bother with it unless I was feeling out of sorts. Routine doctor visits seemed like a waste of time. Why sit an hour in an office to have somebody tell me I was doing OK, which I already knew?
Then my glasses broke, so I went to my local optician's to get a new pair. They did a routine eye exam to make sure my prescription hadn't changed, and in the process noticed something odd about the little blood vessels in my eyes. That led them to take my blood pressure, which turned out to be high. Like, really high. The kind of high where the person giving you the test looks you in the eye afterwards and asks you, entirely seriously, how you are still alive.
I was a stroke victim waiting to happen. (See http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/W...) And I had no idea. And would have continued to have no idea, right up to the moment when my circulatory system strangled my brain to death, if my glasses hadn't broken.
I went to the doctor, they gave me some pills to handle the immediate crisis, we changed my exercise routine and diet a little to bring my blood pressure down for the long term, and now I'm fine. But I don't skip out on routine doctor visits anymore! And neither should you.
But I am moving back to Europe this year so I will go to a doctor there and get all checked up etc.
I'm no doctor, so I'm the wrong person to ask about how often you should see one. But if it's been five years, it's probably time.
https://www.usnews.com/news/articles/2015/12/10/confusion-su...
I personally have my heart rate and blood pressure explode whenever anyone tries to measure them. So I was referred to a cardiologist who did some basic checks like an echo, found nothing wrong and wired me up to a device that measures BP continuously for 24h. My BP was perfectly normal.
High blood pressure will not always be accompanied by easily detectable symptoms like audible thumping. There's a reason why it's called "the silent killer." (See: https://www.cdc.gov/bloodpressure/index.htm).
Also, people who have excellent vision can still benefit from optometrist exams because they can catch early stages of eye problems, and even other kinds of medical problems.
I laugh inside at how consistent she is, so I guess it still works on me.
There is no evidence that routine checkups lead to better outcomes.
http://www.health.harvard.edu/blog/a-checkup-for-the-checkup...
"But what are the true benefits of this practice? Careful reviews of several large studies have shown that these annual visits don’t make any difference in health outcomes. In other words, being seen by your doctor once a year won’t necessarily keep you from getting sick, or even help you live longer."
If your blood pressure spikes a lot when you are stressed that's good to know too. For example I've found that when I drink coffee my blood pressure reacts to stress a lot stronger than when I don't drink coffee.
This was a bit over two weeks after a delayed Transatlantic flight with turbulence bad enough that we barely left our seats.
The main reason I freaked out and took him to the hospital immediately instead of just saying, "that's weird," was that a close friend had had a pulmonary embolism a few weeks after flying back to the US after tearing up her knee skiing (and having to wear a stiff brace on the plane).
Yeah, there are some stereotypes I'm repeating, but they're accurate somewhat often.
I still make sure to get up and walk around frequently on flights now! (As well as the usual anticoagulant libation... Bloody Mary)
Also, if you have any unusual shortness of breath. Pulmonary embolisms are no joke, and depending on how much of the lung has been affected, every minute can count.
In the first case, a clot dislodged and traveled through my heart about an hour after I arrived at the hospital. I had debated waiting until morning as I wasn't sure an ER visit was necessary, but if I had waited any longer I likely would not have survived.
Also, the vast majority of people with PE survive. Depending on the size of the bastard, you can get heart dysfunction and pulmonary hypertension (which can be very severe) down the road.
Basically, unless your blood pressure tanked, your chance of dying from it was probably close to zero.
Not to say it's not a scary thing or that you shouldn't go to the hospital immediately, but we over-diagnose and over-treat PE's all the time. The latter is because we over-estimate their severity.
Yeah, but where do you draw the line? I guess that will sound silly, but I'm always afraid that people think of me as a hypochondriac if I ran to the doctor for every little pain, most of them probably being some sprained muscle or indigestion.
If it could be a heart attack, or similar life threatening thing, you go to emergency.
In the first case, I'm pretty sure I had a panic attack. At least they served me bacon and eggs, probably hoping for a repeat customer with a real heart attack.
In the second case, I'm pretty sure I pinched a nerve in my back. I got shoulder pain associated with movement. I then got pain in the front -- but remember that a nerve pinched in one spot can cause pain to be felt elsewhere. Other back-related issues in the days afterward lead me to my conclusion.
I'm now way less inclined to go in to the emergency room. I don't want to spend 12 hours with an IV hurting my arm, no privacy, no sleep, and not being able to work on anything. One of the times the doctor even cleared me to go home, but the nurses didn't bother to remove the IV for hours afterward. Being in the emergency room isn't harmless; it is a place where diseases spread.
It's a valid diagnosis: https://en.m.wikipedia.org/wiki/Diagnosis_of_exclusion
I once waited four hours to see a doctor because of a sharp pain in the left side of my chest when I breathed more than shallow. The doctor told me it was probably a muscle spasm and to take some Advil. I thought "what an asshole" as I left.
About 20 minutes later, someone told me a joke, I laughed, and was cured. Turns out the doctor was right.
If you had ECG, x-ray, CT scan, echo, and everything looks fine, then the treatment is the same regardless. If you think you had a panic attack or hurt your back, then communicate that to your doctor. It's important.
Edit: thought I'd mention: my wife is currently diagnosed with pleurisy. She went to the ER due to shortness of breath and chest pain a month ago. We've done all the tests possible. She's still in quite a bit of pain. Pleurisy usually takes months to resolve. If you were diagnosed and it disappeared within a day or a week, then you were likely misdiagnosed. However, it does not necessarily mean the prescribed treatment was erroneous.
TLDR: It's probably not a heart attack if you can pinpoint the pain, if the pain gets worse on a deep breath, the pain is related to movement of your shoulder or arm, or if it only lasts a few second.
You should call a doctor if the pain is mild but consistent and is untreatable by pain killers, and remains regardless of if you're resting or not.
You should call 911 or get to a hospital immediately if your chest pain is "crushing" or "squeezing," and especially if it is accompanied by ANY ONE of the following: sweating, shortness of breath, nausea/vomiting, pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms, dizziness or lightheadedness, fast or irregular pulse, severe weakness, inability to walk.
So yea you don't go to the hospital for every pulled muscle, but do your best to memorize the above symptoms of escalating seriousness, and you should be ok.
If you've had symptoms for weeks/months, well, I guess that's probably not a heart attack, good job? Still should have gone in within the first day.
(this is not medical advice!)
https://www.heart.org/HEARTORG/Conditions/HeartAttack/Warnin...
You can search the English NHS Choices website.
That gives calm mostly evidence based advice and lets you know when you should self care, or when you should see a doctor.
For example, here's "chest pain": http://www.nhs.uk/conditions/chest-pain/Pages/Introduction.a...
It says there are a variety of causes, but it says you must never ignore it, and gives some criteria for when you should dial 911.
In England we also have NHS 111, which is a free telephone advice line. It's not as good as it could be because fo obvious reasons they're risk averse.
I say this as someone who has survived PE. In my case, I had pain that was a vague persistent discomfort combined with an evolving sense of panic. I hesitated for a day but then drove myself to the hospital just in time because it had progressed in the emergency room to searing pain where I "saw stars" upon each breath. Literally the most painful experience I ever had.
When you walk into an emergency room and indicate you have chest pains, they will immediately try to assess whether or not you're having a heart attack. After that there are checks to rule out PE and you may have a CAT scan w/contrast fluid.
There are other much less dangerous things that cause chest pain... stress-induced muscle pain is one. The problem is you can't be sure until its too late. Carry health insurance and don't try to second-guess chest pain.
Definitely not worth going to the ER for.
People drop dead too frequently because they wait too long to get help when they have unexplained chest pains that [they think] couldn't possibly be a heart attack.
almost lost a buddy once to a brain tumor around 25. he was light headed with slight pain for a 3 days. checked himself in on day 4 for slight but persistent pain. rushed into surgery immediately. wouldn't have lasted another day.
don't take a chance. would rather be a hypochondriac than dead. a good doctor will respect that.
It's impossible to tell. Thus it would be wise to get checked up just in case.
And I guess they are right. They say our public health care system is excellent.
I don't do annual checkups. They say such checkups are not needed. My employer paid for one at a private doctor when I turned 50. I've heard that if we were more like Canada, that would be illegal.
Hooray NHS free "healthcare"...
Sociologist Lisa Wade, interviewed in New York Magazine, says that 'some scholars argue that being male is the single strongest predictor of whether a person will take health risks.'
Men like risk it turns out. Most of them also hate putting lotion on their skin (too girly) and being afraid of things (not manly). They are also more likely to have outdoor jobs and do household tasks that involve being outside the house. Think lawn mowing and BBQ-ing. They also pay less attention to their skin and so don’t catch early warning signs.
Women, generally speaking, don’t mind lotions, do pay attention to changes in our skin, wear sunscreen to avoid premature aging and wrinkles, and often also wear make up year round that contains ingredients that protect skin from the sun."
"[...] part of the reason that married men, or men with female partners anyway, live longer. They’re nagged into healthy habits and visit the doctor more often."
https://fitisafeministissue.com/2014/08/16/men-and-skin-canc...
He said middle-aged guys with no obvious health problems pretty much only come to the doctor for one (or both) of two reasons: Their wife made them, or they want Viagra.
I pretty severely injured an ankle back in September, at MMA, and for the first time in my life (at 38) it doesn't seem to be healing up very well. I keep finding new little movements that cause it to feel pretty wrong ("popping", "pulling", cold sensation, mild short-term pain, weakness).
One of these happened in front of my girlfriend, who ordered me to see a doctor, so I did. I filled out new copies of all the paperwork I filled out a year ago when I was grievously ill, sat around for a bit, got into the doctor's office, his assistant appeared and asked me a couple of questions, then the doctor appeared after a bit and asked me the same questions again. He palpated my ankle for a few seconds, told me to get a brace, and then left the room without another word.
Unless you're wealthy enough to afford a dedicated physician, there's just really no point in seeing a doctor for anything less than "I might be about to die".
...which sucks, because I'm a huge proponent of preventative medical care. It's just not available for most people.
I think it depends on your doctor.
My GP is fantastic. He's always running late because the company he works for slots patients in 30 minute intervals, but he takes as long as is needed for his patients.
I'm not even close to wealthy ($50k/year) I can go to him for anything from the flu to broken bones to high cholesterol without thinking, "this is pointless".
Why would anyone see a doctor unless they had a health problem? (Or wanted health advice?)
Last I knew though they weren't evidence based.
Quite a few deadly things need to be caught before they become obvious problems. As a crude example, prostate cancer is one of diseases causing death for men; and has the "nice" property that if it's detected early in a screening then it's (usually) treatable with minor side effects, but by the time it causes symptoms serious enough to seek a fix for the symptoms, it generally has grown enough to be lethal.
In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint.
The unequivocal conclusion: the appointments are unlikely to be beneficial.
From https://www.nytimes.com/2015/01/09/opinion/skip-your-annual-...
https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
>Prostate cancer is very common but isn’t always harmful. It is found in 80% of autopsies where the men died of something else. Many more men die with prostate cancer than because of it.
>The screening test for prostate cancer is a blood test for prostate-specific antigen (PSA). This is not a yes-or-no test. It must be interpreted in the context of the patient’s age and risk factors and the rate of rise, and any cut-off level is arbitrary and will miss some small percentage of cancers. If the PSA test is positive, the next step is biopsy. Typically, 12 needle biopsies are done, 6 on each side. They find cancer in 25% of patients. But if you go back and do more biopsies, you’ll find cancer in 25% more patients. Theoretically, if you could see every cell in the prostate, you might be able to find a cancer cell or two in almost everyone, most of which would never progress or kill the patient. So you have to decide how many biopsies are reasonable. If you find cancer on a biopsy, the next step is treatment, and treatments for prostate cancer are not benign.
>In a large European study, screening resulted in an absolute reduction in deaths from prostate cancer of 7 per 10,000 men screened. We can look at this in terms of number needed to screen (NNS) and number needed to treat (NNT). To prevent one death from prostate cancer, 1,068 men would have to be screened and 48 treated. But here’s the kicker: there was no reduction in all-cause mortality. The overall death rate was the same in the screened group as in the unscreened group.
>If a prostate cancer is localized and low grade, it is reasonable to observe the patient and not treat unless he develops signs of progression. A recent study compared surgery to watchful waiting and found no reduction in deaths. Within 30 days of surgery, 1/5 of the patients had complications including deaths. 2 years after surgery, these long term complications were present:
17% were incontinent
81% had erectile dysfunction
12% had bowel dysfunction
>The American Urological Association initially disagreed with the recommendation not to screen, but they have re-considered and issued these new recommendations:
Don’t screen men under 40 or over 70
Don’t screen men with a life expectancy of less than 10-15 years
Don’t screen men age 40-50 who are at average risk
Consider screening men age 55-69 who are at average risk
Consider screening high risk men of any age
Before any screening, doctor should discuss risks and benefits with patient
https://www.uspreventiveservicestaskforce.org/Page/Document/...
>Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal age range of 55 to 69 years. There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death. Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit. The inevitability of overdiagnosis and overtreatment of prostate cancer as a result of screening means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term. The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.
We are slowly learning to do much less asymptomatic screening, though charities and celebrities are fighting against it. Joe Torre still comes on my TV saying "get screened early and often." The generic advice about "always catching cancer early" being an unequivocal good thing is false. Over-diagnosis and over-treatment are huge problems. For another example, thyroid cancer screening in South Korea has resulted in a massive increase in thyroid cancer diagnosis and treatment but not any decrease in thyroid cancer mortality.
I can go on about this topic, but I won't. I suggest reading that blog I linked to, its fantastic.
Because "sedentary middle-aged American eating a typical American diet" (possibly including "fat" as well) might as well be considered a preexisting condition all by itself, and a simple checkup may catch something that can be addressed before it becomes a hospital visit. Most notable as things to watch out for are high blood pressure, high/poorly balanced cholesterol and diabetes or early signs of it. Two of those you can do some checking for at home fairly inexpensively, but cholesterol not so much.
Despite having health insurance (Thanks Obama! while it lasts) I haven't actually had a checkup in probably 5+ years, but after this I'm going to see about getting in and at the least getting bloodwork, etc. which I've been thinking about anyway. Clearly Jason Scott can't be called all that sedentary given all the walking he did during his heart attack, which is why this is a bit of a wakeup call.
Edit:
I'll throw in a surgeon's commentary from when my wife had her gallbladder out: "Men are stupid."
Context: He was noting that most gallbladder problems are in women, that 90% of gallbladders are removed laparoscopically as outpatient procedures, and that of the other 10% where people end up hospitalized most are men because "Men are stupid." Men will try to tough it out and won't go see a doctor until they're in so much pain that they end up in the ER, and the ER isn't going to dink around with a laparoscope for investigation - if things are that bad, they may well slice you open so they can see what's going on and yank it right then and there leaving a nice scar, at least one overnight in the hospital, and some significant movement restrictions while you're healing.
And how many of those women needed surgery?
From a quick read before I dash out the door, it looks like at most ~21% had surgery based on indefinite or vague symptoms. I'd say that there's a good chance that many or most of those cases should have received at the least other treatment before surgery and that some physicians started resorting to surgery too soon once that surgery became easier, cheaper and safer.
That still leaves the other 79%.
I did spend two nights in the hospital (one before the surgery, one after), but I'm surprised that surgery would be considered outpatient under any circumstances. Do they really send people home immediately after putting them under and rooting around in their chest cavities?
I was very sickly as a child. Every doctor's visit did nothing to change this (it wasn't even "Hmm, you have a trend", it was "oh, you have a cold/bonchitis/etc.) It wasn't until I was 30 that I learned I was allergic to pollen, molds, dustmites, cats, dogs, and rats - basically everything that won't kill you (no food allergies I've nailed down) - and that discovery was made when my symptoms suddenly got dramatically worse for months, and I pinned down the only three things that had changed in that time and went to an allergist myself.
Each winter for several years since then I would get bronchitis, and the coughing and shortness of breath would last for months. Every doctor told me to take some Delsym and wait 4-8 weeks. I eventually pieced together that this is my allergies (which, while treated, aren't gone) draining into lungs overnight and slowly being coughed up during the day. Some anti-inflammatory treatment that is now legal in Washington turns out to have stopped that for the last few winters.
I've had two rounds of kidney stones in the last 5 years (each involving at least two stones, because apparently the inflammation from a kidney stone tends to "shake more loose") - Doctors couldn't do much beyond painmeds and flowmax. (First time though, I had a $1000 CT scan (I think it was CT - I get CT and MRI mixed up) because the doc suggested it.)
I had pneumonia once - didn't realize it, it was just a bad cold/cough that got dramatically worse. Calling my doctor for an appt gave me something in 3 days. Day of, I wasn't sure I would be breathing by the time of the appt, so I was going to go to the ER. (which would have been ridiculously expensive). My wife took me to a local urgent care clinic (PatientFirst in VA) because she was worried about the wait time at the ER. They were awesome, saw me immediately as I walked in (they could hear me breathing), did in-house xray of my lungs and o2 sensor. Now that I'm in Seattle, the local clinics work differently - they REALLY want you to have a primary care physician. I recall a doctor there once saying that's because they want someone to coordinate your care, maintain a big picture view, and proactively look into potential issues. I told her I'd never had a PCP do any of those things)
I'm not knocking medical science - it's a near impossible job: "Debug this program to which you don't have the source code, can't control or even know all the environment and inputs, and if you crash it someone dies". It's amazing they can do what they can, and in certain circumstances they are responsible for saving and improving a lot of lives (see above having pneumonia).
But the reality is that if I went to the doctor every time some part of me hurt (and now that I'm 40, that's a lot of parts) based on my past experiences, I'd just spend a lot of time and money and be not much better off. So I'm all for being cautious on big things like chest pains. I'm all for knowing the warning signs of stroke, heart attack, and the like. But going to the doctor for every little thing? Seems a waste.
Still, if I walked into a doctor and said "is anything wrong with me?" with no symptoms or obvious indication that this might be so, they would probably take blood pressure, do a breathing test, ask me if anything was actually wrong, and then wonder why I was wasting their time (or maybe ask if I was looking for a medical certificate cos I didn't feel like going to work, heh).
Like, all those dietary restrictions they give to people who've had heart attacks? Why not give them to me before I have a heart attack, so I won't ever get one? Make my life more of a hassle, so that I live longer!
I want to have someone in my life who plays the same role that a dental hygienist plays a dentist visit, but for my general physical health.
You better not expect doctors to be that. Most of them still believe cholesterol causes heart disease, for example, or that you need 50% carbs in your diet.
I have to think hard to recall otherwise. Usually it would be in context of a specific argument. Maybe I just don't know any hard core feminists.
For example, I know lots of people that want women to be able to be in combat roles in the military. I've not heard anyone suggest that any qualification standard that actually applies to fitness to do so be lowered. Given the biological range of the genders, this would mean that:
* there would be women who physically qualify * that number would be less than men that physically qualify
...and everyone seems okay with this.
Frankly, I've heard far more people get angry about some theoretical upset person than I've ever seen actual upset persons.
There's a difference between taking risks (if you take risks, and bad things happen as a result, that's often outside of your control; e.g. sharks when swimming in the ocean, there's always a risk) and self-neglect, which is within your control. Self-neglect is a consequence of low self-esteem, and has nothing to do with masculinity. This may be uncouth, but: think of the men who you think are least masculine, and ask yourself if they nurture themselves more, go more to the gym, and eat better. If anything, the opposite is true.
The real problem is self-neglect, whose root cause is low self-esteem.
I don't think women's average self-esteem is any higher or lower than men's, but theirs manifests itself in different ways, which explains why women would be more conscientious of their physical health, and push men to do the same. Still doesn't change the nature of the problem, or its real solution.
I'm not sure if I disagree with you, or if my perspective is this same perspective from a different angle, but: I would say that it's more that men tend to (expect to) derive their self-esteem from things they do, rather than things they are—so they invest much more time in doing things, and much less time in being things.
In order to "be" beautiful or to "be" athletic, it's usually a pre-requisite to be healthy—to take care of your body. In order to do things like building a successful business or finding cures for diseases, you don't have to be anything in particular, other than, perhaps, stubborn. So you tend to see things like your own physical health as distractions from "doing."
It's in the "Western man" role-script to "do" things—and to be expected to "do" things by others; it's in the "Western woman" role-script to "be" things—and to be expected to "be" things by others. As long as you "put on the mask", the people around you will generally push you toward playing your part. (This is what a large part of gender dysphoria is about: being pushed by society to play a part you don't identify with, because of what you present as.)
If you don't strongly identify with either of the roles of "Western man" or "Western woman", then the likelihood of you taking care of yourself isn't predictable. But if you do (and a lot of people do), it generally is.
I agree, but that seems tangential to the point. It's a gender difference that has been constant throughout history, and seems arbitrary to want to change. It also doesn't fix the main problem. Making men more feminine will not make them more self-nurturing.
To illustrate, putting on makeup isn't self-nurturing, anymore than getting a haircut. It's not something that depends on your self-esteem, everyone does it. Binge-dieting is self-neglectful (the opposite of nurturing), and so obviously doesn't come from a position of high self-esteem. Being more obsessed about your appearance doesn't make you more nurturing of yourself physically. Again, women don't nurture themselves more than men. You could chalk up wives' willingness to go to the doctor as higher fear of potential negative consequences, rather than self-nourishment.
The question is how do you get men to care more about their health, remember. And changing society or "gender roles" isn't the solution.
> In order to "be" beautiful or to "be" athletic, it's usually a pre-requisite to be healthy
The assumption here is that women nurture themselves because they want to look good, I don't believe that at all. You'll nurture yourself because you'll want to do it, instinctively, without needing any willpower. A necessary condition for that is high self-esteem.
Put another way: if you want to learn better eye contact, you have two ways. 1st: practice better eye contact. 2nd: increase your self-respect. The 1st won't work. The 2nd, will, because it addresses the actual cause. I'm arguing that the same is true for men's health.
That wasn't what I was trying to communicate at all. My intended meaning was that women—by wanting to look good, or to seem happy, or to put on one of the numerous other faces people expect women to present to the world—are forced to pay attention to their own bodies. At which point they will notice if-and-when they're bodily unhealthy. (And in many of the other major roles women play, they're expected to be caregivers: people who pay attention to others, and are paid attention to in turn. Women in such roles have support networks who will notice if-and-when they are unhealthy.)
Men, meanwhile, usually are expected to strive toward goals that involve paying solely external attention—and often abstract attention, to things or systems or concepts more than to people. Their attention will almost never need to be on their own bodies to achieve their goals; and nor will anyone around them (in a professional capacity) pay attention to their state of being, as long as their work is getting done.
The stereotype is at its strongest in war narratives: "valor" is ignoring the bullet in your calf and the stab-wound in your left side and marching on to finish the battle. Because, relative to winning the battle, the state of your body is immaterial. All other stories of "heroism" tend to have some form of this—the mathematician who abuses drugs to find the answer, the entrepreneur who gives a thousand sleepless nights to their cause, etc.
Put women in those roles, and the immediate evaluation (in our culture) changes from "heroism" to "self-neglect." Which tells you a lot more about how our culture thinks of men, than how it thinks of women, since the evaluation for women is clearly factual.
I misunderstood that, you're right.
About your wider point: you seem to put a lot of importance on societal roles ("expected to", "narratives"), and I don't think much of this (if at all) is caused by society rather than self-directed. You're arguing that women are more physically nurturing than men (which could well be true), I'm arguing that it's inconsequential as to how to make men more self-nurturing.
Why do you think so?
My wife did this last year. Out of an abundance of caution they checked in her into the hospital for 8 hours and ran a battery of tests. A full work day and $30k in medical bills later they didn't find anything. By then she felt fine and went home. I'm not faulting the original advice, but medical intervention can be expensive and frustrating.
The USA tells us their model of capitalism is the best. They apply their system to healthcare. It utterly fails to deliver versus "socialist" solutions.
At what point are you guys going to join the dots on this contradiction?
GP didn't say this, though. They said applying the model of American capitalism to healthcare fails to deliver (a reasonable standard of care, I assume). Your assessment seems to largely agree.
Perhaps we interpreted these paragraphs differently because I read it as saying "when are we going to connect the dots and see that capitalism is not the best because it utterly fails in healthcare and thus by extension elsewhere too"
The unrealistic fantasy later capitalists developed as a propaganda to sell capitalism doesn't have those features, but then it also has nothing to do with anything that is, has, or ever could be, realized in the real world.
I'd say, go with what works.
One dispute seems to be over the meaning of the word "access". Some people, like my Libertarian friend, feel that "access" is satisfied if you have the freedom to choose your provider (or none at all) -- but god help you if you don't have any money, because no one should be taxed to pay for others' health care. For many, taxation is viewed as state-enforced theft. (I'm not sure how to argue against that viewpoint.)
Others (like Senator Sanders) believe that "access" means "you can get it" -- and include the ability to afford it in that metric. This is why some people in our country argue that we Should Be making sure that people _get_ their medical costs subsidized by taxes. While it's a tax on all of us, the costs end up being lower, and you don't end up people forgoing routine preventative care because they feel they can't afford it, simply because the chance of them having something catastrophically bad is low.
Many that oppose this point to anecdotes of people who needed Serious Help and could not get to it in time, or flew to the US to get it, rather than in their home country.
The last time I participated in a discussion about this, the best system seemed to be Australian. I'm likely oversimplifying, but basically everyone paid into a national system that covered basic things and normal socialized care, and you also had the freedom to have additional insurance that would cover the things that the national system might not be inclined to give you for various reasons. I liked this idea because it meant that poor people and children all had basic care, and anyone who cared about their freedom to choose their doctors / treatments could do so (at a price). The net price still sounded like it was less than what I pay for my family here in the US for medical care.
The US is a crazy cult for "capitalism" and "free" markets. The problem I have is the absolutism about it. Markets can solve everything. This is the USA position. They force other countries to change to it via the IMF, not content with messing up their own country.
Yet even on a very simple system to model, sports, they have a socialist model. You finish bottom you get the first draft pick. Because when reasoning about a small group of teams it's patently obvious that if you give all the TV rights to the top team, all the draft picks to the top team, you end up with a total mess.
They will probably argue back, "in both cases you're taking something by force," but there are lots of pairs of things that share some traits but not others.
Sharing a trait does not make the two things the same thing (i.e. prison vs kidnapping, again, one is legal and one is not).
> the best system seemed to be Australian
> An important element of the French insurance system is solidarity: the more ill a person becomes, the less they pay.
We all die. The more healthcare technology we invent, the more we can spend. If you are willing to spend unlimited money to save a life, then you will... except that every system finds a way to stop you.
Traditional all-out capitalism stops you when you can't pay. (people also don't WANT to pay with their own money, so costs go down) Some government systems will say "no" to some people, but that isn't too popular. Most common is to say "yes" to everybody, but underfunding means you go on a waiting list and might not make it to the other end of the waiting list. These approaches can be mixed: some procedures for pay, some favored people being able to jump ahead on the waiting list, etc.
Underfunding is a given, because full funding for all the care that people want is impossible. The amount of care desired exceeds the GDP.
[1] https://www.amazon.com/Santamedical-Generation-SM-165-Finger...
(this is not medical advice)
For a pulmonary embolism, on the other hand, I'd expect them to be useful. And always keep in mind that they can't detect carbon monoxide poisoning, even though the blood oxygen is low in that case.
Indeed the vast majority of patients with an acute heart attack would have completely normal pulse oximetry findings, the only way to properly diagnose a heart attack is with an electrocardiogram (EKG) and/or blood tests to look for markers of heart muscle damage
Also, having a surgery while being awake? Not sure how to think about that. I mean just imagining that makes me feel weird.
It's a form of x-ray video with a tracer in the blood, so they can observe both the guide and the blood irrigation.
The doctor will use live x-ray pictures to carefully guide the catheter up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps the doctor see any blockages in the blood vessels that lead to your heart.
A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.
Jason, I think it's an understatement to say that you've done incredible things on the accomplishments/legacy/contributing-to-society front. Thanks for your incredible work.
I hope the next however-many-years allow you to do all you wish to on the person/relationships/plans front. Godspeed!
Anyone else have experience with cholesterol in early 30's?
The weird beating seems like my heart is either beating normally or weakly and then there's a "hiccup" every minute or so. When I lay down with my ear against the pillow when this happens, I can hear my blood flow, which seems weird, like my blood containing tubes/pump is wider than the amount of liquid in the chambers; like an echo-y water flow sound.
Part of me thinks this is the L-arginine I take (to get "swoll" as they say) combined with the amount of caffeine I take in? Another part of me thinks this is a valve issue from bacterial endocarditis, since I still have my wisdom teeth, though I brush 3+x/day, but I've had 2 splinter hemorrhages without trauma on my fingernails recently, though I like any signs of Osler nodes.
I'm 6'1", 184-ish, muscular build, so maybe it's all in my head and the above paragraphs are the result of hypochondria exacerbated by a lack of health insurance or the money to even pay for a routine doctor's visit. I mean, I eat all healthy homemade food; currently cooking black beans + garbonzo beans to make a hummus of sorts.
Hoping my anxiety stays tempered long enough for me to get back on my feet while finishing my current project.
EDIT: I forgot to mention a frequent shortness of breath, though like in Jason Scott's case, this doesn't seem to prevent me from physical activity, but it bothers me that I can't take deep breathes all the time.
(this is not medical advice - go see a doctor!)
Edit: replaced french word
I also went to a cardiologist about it, and he pretty much just said "your EKG is normal and you're fat, work out 7 days a week, have a low fat diet, and lose weight".
It stopped being anywhere near as frequent, along with a drop in resting heart rate, lower blood pressure, less back pain (probably due to less inflammation) once I went on a low carb diet (notice the low fat diet the cardiologist suggested didn't help much) last year. I also lost 45 lbs in four months, mostly just the diet. I certainly didn't work out 7 days a week.
I have periodically cheated since, and each time I get a reminder I shouldn't because I get skipped heart beats, tightness in the chest, and an elevated heart rate and blood pressure.
I'm not sure the mechanism behind this (anyone? local doctors have been completely unhelpful), and I almost wish there was another cause, because every once in awhile I really, really want to have those carbs, but I feel a lot better overall when I don't.
Something to consider.
I have a hietal hernia[0] that causes reflux and dyspepsia (trouble swallowing) and mimics these heart symptoms: shortness of breath, arrhythmia, chest pain, and tachycardia. A ketogenic diet helps, as does an OTC PPI[1] (e.g. Prilosec, Nexium). You might consider getting scoped to see if you have one as well (or just take a PPI for two weeks and see if it helps).
I've had arrhythmia since I was a teenager. Some of it is sinus (i.e. pressure on my vascular system caused by breathing) and some of it is not[2]. I've found that taking a daily multivitamin helps considerably, as does a diet rich in magnesium and potassium (occasionally supplemented), so I must have some deficiencies. I can't take too much pseudoephedrine (and try to avoid it completely after a particularly scary episode). Regular exercise helps as well. If I start to freak out about a particularly bad spell of arrhythmia and/or palpitations, I tell myself to eat an apple or a banana and go for a walk.
Alcohol and caffeine wreak havoc on all of the above, so I can't drink like I did in my 20s, and I try to limit myself to one pot of coffee per day. ;-)
> "your EKG is normal and you're fat"
If I had a nickel for every time I've heard that...
If you have bacterial endocarditis[3], that could explain why a low-carb diet is helpful: lower blood sugar -> less fuel for bacteria -> reduced heart valve inflammation. Maybe.
I have something else going on right now that I don't understand: waking up at night with back pain under my right shoulder blade, anxiety, and arrhythmia. I went to the hospital after the third incident and the EKG, blood work, chest X-ray, CT scan, etc. didn't reveal anything. I suspect it's stress-related and either an ulcer or bacterial endocarditis, so I need to get those looked at by specialists. I also had a clot in my leg last year for which I needed six months of blood thinners, so I wonder if that's related...
Getting old sucks.
0. https://en.wikipedia.org/wiki/Hiatus_hernia
1. https://en.wikipedia.org/wiki/Proton-pump_inhibitor
2. https://en.wikipedia.org/wiki/Premature_ventricular_contract...
I also just got an MRI and an ultrasound for a hard lump on my leg to make sure it wasn't a clot (they thought it was cellulitis but antibiotics didn't make it go away, now they think it was cellulitis and the remnants just might just stick around for awhile).
Honestly I'm just tired of getting all this checked out all the time. I max out my rather high deductible pretty quick these past couple of years, mostly to get tests taken that (so far) have been negative, so I don't really know what's actually wrong (although apparently the doctors don't ever think it's too serious, but I'm worried they make some assumptions because of my weight and something more serious might be hiding).
I agree, getting old sucks. And I'm still considered too 'young' for half the things they're testing on me, from what they keep telling me.
Some more info:
Skipped beats are often normal (see PVCs, PACs).
A highly irregular rhythm, e.g. where your heart goes beat..beat..beatbeatbeat.beat...beat..beatbeat may be a sign you have Atrial Fibrillation, and you should definitely jump on that if you do.
* Sitting a lot (Standing desk didn't help, regular breaks and walks did.)
* Diet (Carbohydrate heavy)
* Alcohol consumption
* Lack of intense exercise.
Of all of those, diet and alcohol consumption were the most important. No one really understands how these metabolic processes actually work, it seems.
I think based on Obamacare, this is actually copay free for most/all insurance plans. Cholesterol screening is included [1].
I strongly recommend everyone to take advantage of the free preventative care (until Trump/GOP kills it)
[1] http://obamacarefacts.com/questions/exactly-covered-preventa...
I also used to work with an older guy who had known heart problems and a defibrillator. He worked on a piece of equipment that required him to lean over a big moving dangerous piece of mechanical moving death trap. One day we noticed him leaning in in a weird way, jolting and then getting back into the correct position as if nothing had happened, it happened three times during a week. We talked to him and he just insisted he was tired. But the shift boss took him off the equipment and told him to go see his doctor. They checked his defibrillator and it had gone off something like a half-dozen times in that week. His heart had stopped and he would have died a couple different ways if he hadn't had that thing in his chest. He never even knew anything was happening except feeling lethargic. But he wasn't passing out, he was dying.
Jason Scott on the other hand had lots of discomfort, but didn't realize it was his heart at all. The signs of heart trouble are so many and this just reminds me of how unclear they can be. We're a lot better off with a Jason Scott than without, so I'm delighted to hear that they caught the trouble and sorted it out with what sounds to be a miracle of modern science.
If you're unfortunate enough to suffer from something like anxiety attacks and also have heart trouble in your family's medical history it is very difficult (and expensive) to ascertain if you're having a panic attack or an actual cardiac episode.
Edit: Data science types wanting to tackle this problem, check out https://physionet.org/challenge/2017/
Are you charging people for a beta test?
a) A twelve-lead EKG - which requires twelve wires to be connected to specific locations on your body
and
b) Blood tests
Therefore for a consumer-grade device to properly rule out a heart attack it would need to be a large EKG machine with multiple connectors as well as a blood test analysis machine. And that's not even considering that proper analysis of an EKG trace requires a trained medical professional, as the automated traces are notoriously unreliable
There are other heart conditions that manifest intermittently for which a Holter can help diagnosis. There are a few companies out there working on innovative approaches to make the Holter less cumbersome -- I think iRhythm's ZIO patch was the first on the market and there's several more now. There also some interesting evidence that more subtle signs in the EKG or even unrecognizable-to-humans features of the electrical signal can help proactively predict heart attacks before they happen, but I think that's not yet validated or ready for clinical use. If those type of metrics/analyses prove useful, you could make a case for using Holter-type monitoring to identify a heart attack before it happens
It was incredibly useful, and helped me learn what the different feelings in my heart mean. I know exactly when I am in AF and when I am not.
There seems to be a huge gap for this kind of consumer grade offering, probably because the medical fraternity is extremely conservative about any technology, even though the alternative is ... nothing.
Go to a doctor and get checked out to rule out any heart issues. If it's panic disorder, there are safe drugs that are great at making these symptoms go away.
He was literally dead for 20 minutes, but they managed to revive him and a few weeks later, with a newly installed pacemaker, better than new.
He had a very, very, very high probability of dying, or requiring specialised care due to brain damage from brain hypoxia. Those that knew CPR, and did it properly for those excruciating 7 minutes gave him his life back.
The moral of the story is, if something feels awry, go and see a doctor (he wasn't taking it seriously), and learn CPR, you might just save someone's life.
Oh, and our hospitals and doctors/nurses are top notch. He was in intensive care for a few days and the final bill was a few hundred dollars. Hooray for universal healthcare!
I've had several more subsequently and went straight to hospital each time. Thankfully I haven't had a recurrence in years now, but I learned the same lesson the author of this post did - you shouldn't ignore chest pain.
Since the entry was written last week, I went back to the Emergency Room twice. The first was because I was just feeling "a little weird", and they did a round of tests and verified that no, I'm healing fine, that's just how I feel now (I feel less weird every day). The second time was a few days later when I experienced a notable shortness of breath. This time, the cardiologist said it was likely a side effect of one of my drugs (it's known to do this) and we swapped the medication. Now I'm feeling pretty great.
I mention this because one of the themes of messages in here are "I don't want to be a bother/I don't know if this warrants a trip to the ER" and those two thoughts should NOT be calculated into your deciding to go. Believe me, they'd MUCH rather work on "guy feels funny" than "guy got shot by other guy in argument over the Playstation" or "Guy drank so much he crapped himself and fell onto a sprinkler and is bleeding profusely".
The doctors thought I should not fly for two weeks after the procedure, so we booked an AirBNB for the extra time. My hosts of the two events I spoke at (ACMI and MuseumNext) have essentially paid for this entire extra AirBNB time, which is generous and wonderful and I give a shout-out to them. Additionally, the hospital gave me a letter indicating I couldn't fly, and MuseumNext was able to move my international flight with no real added cost; that's also worth a shout-out. Melbourne is a very nice place to be resting.
The main annoying part is I was (mostly) doing the right things, health wise - I had dropped 30 pounds, and was walking like crazy - I'd upped my step goals on the fitbit after I kept smashing them. On a trip to Japan last year for three weeks, I'd walked over 160 miles. I'd done this because I'd seen so many contemporaries drop dead or get really sick in their 40s and 50s - computer life is not a healthy life. The silent and unaddressed problem, on my side, was cholesterol - it was choking my arteries. Drugs will help that, but I've now radically shifted my diet to approach it naturally as well. I'm raring to go on long walks again, so I will definitely continue that. But please bear in mind - I might still die! Nothing is guaranteed!
I also see a lot of differing opinions on "see doctors" versus "not see doctors". I can't imagine how having a regular doctor checkup is in any way bad. It might not affect what you DIE OF, but it can't hurt quality of life - when I had bad kidney stones for years, it was certainly my doctor who gave me the drug that fixed that. And other small notes have made my life better as well.
Money/cost issues are worth a whole other post.
Finally: I see that 25% of the thread is an argument over linking to the title versus describing the essay's contents. I see people are VERY INTENTLY CONCERNED over the two sides in this discussion. As always, HN knows where to aim the energy.
Pharmaceutical pills have all sorts of additives intended to delay the release of the active chemical, recreational pills have an obviously less rigorously tested version of the same.
My mother, a (retired) cardiovascular pharmacologist, taught me that the quality/effectiveness of those additives is often what differentiates brand name drugs from generics (sometimes significantly, admittedly she's been retired for quite a while now, so that information might be out of date, but she actually did some professional research on the subject back in the day).
I'll never forget the time when I, at about the age of 11, was sent in to the store to buy a big bottle of Aleve that my mom was going to "smuggle" across the border to Canada for her sister (Naproxen was prescription only at the time in Canada, but available OTC in the US - amusingly, Tylenol w/codeine was the inverse). I bought a generic naproxen sodium instead (thinking I was so clever for saving about half the money I'd been given), and I got chewed out and sent back into the store to replace it. That was what she got for teaching me to actually read the active ingredients of drugs on the label ;)
Better safe than sorry, especially where the heart is concerned.
Seriously though I wish him a full recovery and we all need to remind ourselves that all too often we lose track of what's really, life stoppingly, important.
I wish him a fast and full recovery, too.
If you're feeling chest pain, please don't mess around. Get checked immediately. Better to feel silly than miss a heart attack and die!
He's been featured around here a few times: https://hn.algolia.com/?query=textfiles.com&sort=byPopularit...
One of the more memorable posts was the one where they worked frantically to preserve a warehouse full of old manuals: https://news.ycombinator.com/item?id=10076974
https://en.wikipedia.org/wiki/Jason_Scott
(and even his cat has a wikipedia page: https://en.wikipedia.org/wiki/Sockington)
Glad he's doing OK. Good vibes, Jason!
document.body.style.fontSize = '14pt';
document.body.style.fontFamily = 'Georgia,Cambria,Times,Times New Roman,serif'I cringed when I read he was chugging energy drinks to stay awake, given the context of the post.
I wonder after reading, is Wikipedia the new "Who's who in America?"
>[His] Wikipedia page.
As a practical matter, the policy seems to amount to "We use the title of the original article, unless it is strongly stated, in which case we regard it as clickbait and change it to something dull." That is not a good policy, since we should all hope for and promote strong writing, and the fact that a strong headline could be confused for clickbait is not a good reason to change it. Nor should the default be "use the article's original title" since a better default would be "Highlight what part of this article would be interesting to the Hacker News audience."
Much of language derives its meaning from its context. In the context of this blog a title of "The Other Half" can have a very different meaning than a title of "The Other Half" on Hacker News. Lifting the title verbatim to a new context can change its meaning. Even though the intention may be good to be faithful to the original, purely by being in a new context, the title has been effectively changed. In fact, using different words for the title in the HN context can well be more faithful to the meaning than the using the same words.
I could go on about this for hours. Of all the things that make HN different and matter most, this is the one I'm surest of. However, after yesterday I think a better use of resources would be to go back to working on making HN faster. There the difference between 1 and 10 seconds really does matter.
This is one of the oldest meta-arguments on the site. Once or twice a month, perhaps, we get a story that isn't particularly well served by the guidelines, and people have to click one more time than they might have, or read a few more sentences than they might have. But pretty much every day, and probably more frequently than that, we see problems stemming from the guideline being broken.
Almost everybody reading these comments knows what this story is about now. It's a shame a pointless meta-complaint is bolted to the top of the thread, instead of something actually about the post itself.
I still think it's not going to work out. There aren't many moderators, and fixing the titles on this site is a huge amount of work. For instance, it's also probably not reasonable to expect the mods to read every story on the site, or even just the stories with broken titles.
A thing you can do to help is, when an article has a title that doesn't follow the guidelines, suggest a better title. The mods often use those suggestions as the replacement title.
Then please email him and the mods directly at hn@ycombinator.com
ADD: in order to keep a high signal to noise ratio. Comments on stories should be reserved for discussing the contents of the story, not meta issues with the forum. For meta issues either email the mods directly or start a meta thread with a Ask HN: post.
From the site guidelines[1]:
If the original title begins with a number or number + gratuitous adjective, we'd appreciate it if you'd crop it. E.g. translate "10 Ways To Do X" to "How To Do X," and "14 Amazing Ys" to "Ys." Exception: when the number is meaningful, e.g. "The 5 Platonic Solids."
Otherwise please use the original title, unless it is misleading or linkbait.
Please don't post on HN to ask or tell us something (e.g. to ask us questions about Y Combinator, or to ask or complain about moderation). If you want to say something to us, please send it to hn@ycombinator.com.
If stories are community property, then the community and not the editors should decide whether the story submission with the title it was submitted with was valuable or not by upvoting it (or not).
"Submitting doesn't entitle you to choose for the whole site what is or isn't interesting about a story."
I don't see why they couldn't. But using the same argument, the editors shouldn't get to choose for the whole site what the title should be either.
I've run across so many, many great stories with super generic, boring titles that will never be even glanced at by most readers. Those stories deserve better, and editing the title to make it reflect what the story is actually about is helpful.
HN editors should restrict their roles to keeping the conversations civil, and let the community take care of the rest.
Indeed they do, and there are other strategies for achieving that than gutting HN's approach to titles which is critical to how the site functions.
If you have links to stories that fit that description and haven't had attention on HN yet, I'd love to see them.
Also, doesn't having to run stories past a gatekeeper go against the community rating system that HN is based on?
I don't see administrator interference in story titles as particularly critical to the site, but community voting on stories is.
Is there maybe some way to experiment with leaving story titles unchanged from how they were submitted? What would happen if HN tried that for a week?
I found it riveting.
Man finds wife's head in box. Therapist of boy who sees ghosts is a ghost. Man who killed hero's father is actually his father.
I get that you want more information, but sometimes getting the information makes reading something less pleasurable. The author here doesn't disclose the detail you're talking about until a third of the way through. Disclosing it in the title fundamentally changes it, and not in a good way.
Nobody is asking for the hyperbolic titles you gave, they simply would like to know what they are getting into before clicking on some random link.
EDIT: see: https://upload.wikimedia.org/wikipedia/commons/b/b8/New_York...
Basically an unbeatable news consumption interface. Notice even the smaller headlines down the page, which are either independent lower-importance articles or minor articles related to the major ones above. You can read ~15-20 words on each the give you the basics of what happened, very quickly because it's called out in larger type and because the authors were competent and weren't trying to drive clicks, but to deliver value.
If you don't want to read that style of writing, then I would suggest not clicking links with this style of title.
And hey, I love "Frank Sinatra Has a Cold" as much as the next person.
The largely fluff (imo) articles from nautil.us and the like are generally left with the original article title intact. The essay is left to the reader.
As for news and technical articles, these are expected to make a clear and concise argument or statement of facts, and the title linking the articles is expected to be accurate and informative. This seems like a pretty fair standard.
The forum as a whole is content and audience sensitive, fairly inclusive when it comes to topics, and in my opinion generally gets it right when it comes to adjusting post titles.
News is meant to inform, and non-creative titles are part of that.
Look at any decent newspaper and the headlines will look like your satirical movie titles. HN is much closer to newspapers than movies.
Nowadays, people decry anything that isn't a completely literal summary of the article as "clickbait", ignoring decades of history and hundreds of masterpieces.
in this case, the actual "event" is not mentioned in the first few paragraphs. This is clearly a literary choice made by the author, and changing the headline would defeat his intentions and be somewhat lacking respect.
Here are some historic examples, and The Atlantic's humorous efforts at de-phantasizing them (from https://www.theatlantic.com/technology/archive/2016/08/famou...):
– "Frank Sinatra has a Cold"
(Frank Sinatra Is a Complicated Person (and Unfortunately Our Reporter Did Not Get to Speak to Him))
– "Ford to City: Drop Dead"
(Ford to New York City: Drop Dead (but He Only Means That Figuratively, As He Intends to Veto Any Bail-Out for New York City’s Municipal Budget))
– "Death of an Innocent"
(A Young Man Hiked Into the Alaska Wilderness and Died Under Somewhat Mysterious Circumstances, and Also His Ordeal Raises Larger Questions About American Culture)
– "Pearls Before Breakfast"
(Most Commuters Didn’t Even Notice When a Violin-Playing Prodigy Masqueraded as a Street Performer)
– "Headless Body in Topless Bar"
i don't know what you mean by "strong writing" here.
It's true that one can trade that off for immediate factual placeability, but on HN we prefer to make the opposite tradeoff. That's one of many reasons why the guidelines say "Please use the original title, unless it is misleading or linkbait." (https://news.ycombinator.com/newsguidelines.html)