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danachow

796 karma · joined July 19, 2021

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danachow··on Only 6.8% of adults have optimal cardiometabolic health
>> and having seen a lot of lipids/HbA1c I have to say I have never seen results this good in anybody else.

> point is that I have not seen better numbers in any patient.

Well that’s a biased or too small sample size. 2.19 is a great number for most adults (barring those with very high risk ASCVD where these days we want to squash it down much lower) - and if you were my patient I would be congratulating you but alas you are just a rando on an Internet forum where we can discuss data dispassionately and.. https://www.ahajournals.org/doi/10.1161/circ.106.25.3237 If I see only 20 patients in clinic or realistically a cohort of clinics that is representative of the American population I expect 1 or 2 to pop better numbers.

It’s better than average but not rare or uncommon by even American standards (and don’t look at the Dutch numbers if you want to feel good about yourself).

danachow··on Only 6.8% of adults have optimal cardiometabolic health
Well then you have all you need to figure it out. If low LDL is good then high HDL to LDL ratio must be good, so low HDL would be bad.
danachow··on Only 6.8% of adults have optimal cardiometabolic health
> I added some genetic background. That definitely isn't it.

It isn’t “it”, but you sure as hell know that lipid metabolism has a considerable genetic component.

> Mother is on statins now in her late 60s.

Even with your lipid levels posted if you have even a touch of hypertension you will have an indication for statin in your late 60s based of CV risk.

Seriously I am happy that you’re physically fit and doing well not trying to diminish that - but I could not help but be amused that you’re flexing off of results seen in medical training. Granted some of us train in relatively healthy areas - but I trained and work with a patient panel with A1c often in the teens - so just the thought of gauging my own progress off that comes off somewhat sadly as ludicrously funny.

My somewhat tech related story was we recently had a transfer patient with an A1c of 127. The limit on these assays is typically around 20% - but apparently the lab interface in this case stores A1c as a signed 8 bit integer and a maxed out value as +max - after mentioning this the endocrinologist gave me a blank stare and walked away.

danachow··on Only 6.8% of adults have optimal cardiometabolic health
> Yes, I am pretty proud of myself!

Congratulate your parents as well for the good genes.

> I also love candy, and will eat a lot of it while coding or studying. Never skimped on things like popcorn, triple butter please.

> I think the key is, you have to use absolutely everything you put in your body. If you are not building a stronger body with it, it's going to waste.

I mean I’m totally in the indulge in moderation crowd if only to enjoy life, but I am still at a loss how your two statements above are connected. How are you building a stronger body with the triple butter?

danachow··on Cow Clicker (2010)
Yeah because there’s a real vacuum of pretty looking but content free addictive micropayment games. A real big loss to society that has not been replicated that one.
danachow··on Only 6.8% of adults have optimal cardiometabolic health
Pro-tip: if you’re trying to flex, it’s high HDL.
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
Ah, ok, so it was just bullshit. It’s virtually impossible to become hypokalemic from dietary insufficiency alone if maintaining caloric needs unless you’re puking or shitting your guts out or have certain endocrine or renal chronic illnesses - not over 2 weeks. And a headache is entirely non-specific - it may have completely resolved on its own as they usually do. We have to meet a certain rigor - we can’t just say oh headache it must have been some dietary indiscretions and low potassium with no evidence - that’s not how any of this works.

If you were critically and symptomatically hypokalemic a couple handfuls of baby spinach would not have corrected that deficit.

> Lots of sodium, no potassium, things get out of wack quickly

If you don’t have an endocrine or renal disorder or taking certain medications - no, they really don’t.

Sitting in the position of the doctor - there’s no way to counter this. You immediately jump to the conclusion you’re symptomatically having headaches because of hypokalemia based on no evidence whatsoever and just a coincidental diet pattern but with no concept of potassium homeostasis - there’s really not much I can do to convince you otherwise if you are inclined to jump to conclusions that quickly. It isn’t supported by basic biology and a practitioner actually has to show some consideration in their diagnosis. You’re going to chalk it up as being ignored. And there we are.

When somebody generally healthy comes in with an episode of a non alarming headache - conservative management is the evidence based standard of care. Come in for follow-up make sure the BP was a transient thing. Maybe have you do some home monitoring. Perhaps your diet is shit, but the potassium would likely not be the problem.

If you really think you’re chronically hypokalemic - maybe get a basic blood test (you can order them yourselves these days - take it when you think It’s low) and take it to a doctor if it’s low. I’m sure it’ll be normal though - and you will have no further diagnosed your headache - just like your doctor.

Also 160/90 is not a great blood pressure to be living with day to day - but it is not "dangerously" high - or what we would call urgent or emergent. BP can be transiently elevated in pain or stress states and 160/90 isn't going to kill you. If you keep coming in with that or better yet you have multiple readings at home like that, we'll talk about lifestyle changes and then maybe talk about a chronic BP medication. But there is no reflex reason to do any lab workup just because a BP is 160/90.

What is considered safe blood pressure and how we should control it both chronically and acutely is something that has undergone a stupendous amount of thought and research since hypertension became a major health concern 75-80 years ago. Not immediately doing every lab test and imaging study in the book for a one time BP reading that high is not based on some capriciousness - it's based on some of the most basic and well-trodden evidence based medicine. It's not as cavalier as the assumption of many here.

danachow··on Robertson vs. Torx screw drives (2021)
>> At the moment they're a hard bit for a layperson to find, regardless of their advantages

That was the original comment, that is all I responded to - which is just a completely ridiculous.

And if you work on cars, you'll encounter the fasteners all the time.

But there's a very popular construction screw sold at Home Depot, etc that uses a "star" bit. The overall fastener selection at Home Depot isn't amazing, never has been - they've never been much of a hardware store. Check Grainger or something.

danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
How would you have done your diagnostic workup differently than what was done - specifically?

What was the negligence what was the diagnostic smoking gun that was missed?

> I feel that patients are qualified to comment on medical standards of care, also.

Patients like doctors is a huge group that should not be generalized - but health and healthcare literacy is pretty bad so by and large, no, patients can comment on standards of care but they aren’t qualified to do so.

danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
This is a good learning/discussion point: The post common cause of iron deficiency anemia in menstruating females is menorrhagia. Celiac disease is often an acquired disease in later adult hood.

This is not to comment or challenge directly your case but knowing the two above facts it is not uncommon (in fact I have personally seen this in practice) where your above outline is perfectly reasonable.

A woman may have multiple reasons or a sequence of reasons for IDA, developing celiac later in adulthood - it’s totally possible they had chronic blood loss anemia before that.

danachow··on How did a woman with a missing temporal lobe become bilingual?
The brain doesn't typically rotate inside the body - a person referred to as left handed today was the same as someone left handed 100 years ago... Got it? -- some of us are even old enough to know people alive in the 1920s and prior, but there are plenty of books to confirm this... the prevalence of right and left handedness didn't swap sometime recently.

The left brain is the side of the brain that is on the left side of the body. There was no reason to ever make it more complicated than that.

100 years ago is not that long ago - so the snark is more about the "how can we possibly know?!?!" tone - you can look it up - I think 1800s editions of Gray's anatomy are scanned online. Wikipedia still uses the fucking things from the 1910s because they're out of copyright - https://en.wikipedia.org/wiki/Human_brain#/media/File:Gray65...

danachow··on Robertson vs. Torx screw drives (2021)
Oh in that case you're just very apparently 40 years behind?, there are kits sold in supermarkets in the US that carry Torx bits. They are not uncommon at all.

In addition to automotive it is all over appliances, electronics (eg hard drives), laptops, small electronic devices including smart phones.

The Husky toolkit I purchased from Home Depot 25 years ago included Torx bits.

Here is even a tamper resistant kit you can get at Home Depot: https://www.homedepot.com/p/Husky-Magnetic-Tamperproof-TORX-...

I am actually stupefied that someone can differentiate Philips from Pozidrive but isn't aware you can pick up a Torx driver set from any Walmart or Harbor Freight.

danachow··on Robertson vs. Torx screw drives (2021)
Where do you live that Torx are hard to find? They are nothing short of a standard on automotive applications, and any "mechanics" screwdriver, like the very popular Megapro in North America will carry Torx bits - but any big box store selection will include them.
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
The otherwise healthy man with no iron deficiency has no reason to take daily iron supplements for 5 years and therefore no need to monitor iron levels. If they are iron deficient there is some sort of blood loss or underabsorption going on and if and until that is corrected an oral iron supplement is unlikely to cause toxicity. If it is corrected, then iron replacement should only take a few months.
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
How did you confirm the potassium deficiency? How low was it?
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
From my reading of that story what was interesting was that shit hit the fan with a post-op infection after the hernia repair. A reducible hernia isn't an automatic indication for surgery these days - and post-op risks outweighing benefits is one of the reasons why. It's also weird why the "time left untreated" would have any bearing on the repair and risk of complications - people go through life with uncomplicated hernias for years - if they're complicated they declare themselves pretty rapidly. There are many other reasons I can think of that would increase risk though. When I hear a story like this it is very hard for me to believe the entire pertinent medical history is being conveyed.
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
> I’m sure you’re here to rub your reflex hammer in our ignorant little pig faces.

I do realize there are a lot of crappy doctors out there, but about the person putting a reflex hammer in your face -- are you sure that was an actual doctor?

To your other point, while I often realize the futility of responding to the direct commenter, this is a public forum so maybe others can get some information or entertainment, whatever might be.

danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
Dude, I'm just addressing this: "So things that can look like anemia can be other things! Case in point, my wife was misdiagnosed for months with Anemia."

Which is a bit of a confused statement.

> Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness.

No, that's a pretty shit analogy and completely wrong. First, because chemotherapy doesn't cause "male pattern baldness" - the mechanisms aren't the same. So that's just wrong - while someone with a hemoglobin of 4 has anemia, whatever the underlying cause may be - it isn't a look alike - it is.

Second, diagnosing Alopecia (secondary to chemotherapy) is a perfectly reasonable diagnosis. Because it is something that doctors do manage with specific things separately from the chemotherapy and other cancer treatment, eg wigs, scalp cooling.

People can have more than one relevant diagnosis that they are treated for and are interrelated. For instance, if someone has anemia that is due to something like a GI bleed, they have both a GI bleed and anemia. If their hemoglobin is less than 7 you will likely treat that anemia with a blood transfusion independent of what you're doing to manage the GI bleed. GI bleed, iron deficiency, malabsorption, microcytic anemia are all diagnoses - they may be all interrelated.

> A more accurate and helpful diagnosis would probably be something like "Babesiosis"--anemia caused by ticks

But babesiosis is not anemia. It often occurs with it, but the diagnostic criteria for babesiosis is blood smear or PCR. If someone has a smear positive for babesia then they have babesiosis regardless of their Hgb/Hct.

And notably they listed a bunch of tick borne illnesses listed, babesiosis was not among them.

danachow··on How did a woman with a missing temporal lobe become bilingual?
Yes, the word left 100 years ago means the same thing it does today. And the gross anatomy of the brain goes back beyond that.
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
A hemoglobin for 4-5 is anemia - the definition of anemia is low hemoglobin concentration. If your wife had hemoglobin that low, then she was correctly diagnosed with anemia.

It is a bit odd though the apparent coinfection with multiple tick borne illnesses from different species of ticks - A lyme and ehrlichiosis coinfection is not surprising, but rocky mountain spotted fever is a very different illness, often more acute in presentation with distinctive signs and symptoms - but coinfection with the other two would be quite rare.

Also, those specific tick illnesses listed are unlikely to cause that profound of an anemia by themselves, so there's probably some other pathology going on - the tick borne infection may only be a trigger.

Any relatively young person that is otherwise healthy (no near end state kidney disease) should definitely get referral to a hematologist for hemoglobin of 4-5 if it isn't something blindingly obvious like blood loss.

danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
I'm not the biggest fan of twitter but this is a practicing internal medicine doc that is conveying information primarily aimed at other doctors in training or practice - this is information that is for the most part readily available, nothing groundbreaking here, there are podcasts on the topic, videos and other paid for sources of information. The novelty is the medium - and if there are some that benefit from it and the like the format I don't see the harm.
danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
Frequent monitoring of iron/ferritin levels while on oral iron supplementation is likely not necessary -- barring a genetic disease, you're extremely unlikely to get iron toxicity or overload at instructed oral doses. Periodic monitoring is more to assess a positive response - since if your levels are not going up on supplementation it warrants further investigation.

Oral iron is now recommended given only every other day to avoid GI side effects and there is evidence that the response is just as good to more frequent.

danachow··on Why does iron deficiency cause fatigue, even in the absence of anemia?
Ferritin is the protein that stores iron in cells in almost every organism from bacteria to humans - but its exact structure and mechanism do differ. As a blood test, endogenous ferritin level gives an indirect measure of iron stores. Ferritin <25-30 ng/mL is consistent with iron deficiency anemia - levels higher than this are more difficult to interpret - they don't rule it out.

Whether or not consuming plant ferritin (when you buy "ferritin" supplements that is what you're getting - usually a pea plant) is an effective iron supplementation is another question entirely. And as far as I know there is no great evidence that it is non-inferior to typical oral iron products (salts and saccharide compounds). The ideal treatment for iron deficiency anemia is typically IV iron (or blood transfusion if the anemia is profound enough to warrant it - but IV iron replacement is one of those things coming back into fashion finally after many years of being feared for reasons with poor evidence.

danachow··on Logitech MX Products are incompatible with AirPods
> It was their choice to invite consumer complaints about radio interference in unlicensed bands using a crafted UI.

When I go to the FCC link you posted, I don't even see what you're talking about. I see a menu of: TV, Phone, Internet, Radio, Access for People with Disabilities, and Emergency Communications, Affordable Connectivity Program and "Tell us Your Story". None of those initial menu options would even apply - this isn't disrupting your TV, Phone, Internet or broadcast radio services. "Tell us your story" is just a free text entry form - nothing about radio interference/unlicensed.

So maybe you can clarify.

>> Are you hoping they will carve out a slice of new spectrum for AirPods and give it to Apple for free?

> No.

Well then what, really? Why not just call the police then? If each company is selling an FCC certified device that is running within the parameters of its certification (which is likely the case) - the FCC has nothing to act on. You are asking the feds to intervene on no actual rule breaking. Devices sharing the "trash" ISM band are often going to interfere even when operating within specification. You might have a better bet with the FTC or a civil case. Yes, it would be nice if Logitech or Apple did something to play nice, but it's not a federal communications regulations issue.

Also you asked for the FCC to respond. If you look at the FAQ, the FCC does not directly respond to consumer complaints - it would totally overwhelm them with the terrible signal to noise ratio. They indirectly respond insofar as demanding a response from the provider for service related issues https://consumercomplaints.fcc.gov/hc/en-us/articles/2050828...

danachow··on The GPU shortage is over
No disagreement on any of this - I would not trust the second hand miner stuff wasn’t treated like shit myself either.
danachow··on Why your next home computer should be an old Xeon workstation (2019)
> unobtainium or $850

In fairness the Marantz is being purchased for a collector’s aesthetic - not just for a “value” PC which is the whole point of the old Xeon - the price rise is limited by this elasticity in demand.

And $850 I think is illustrative - that’s not unobtanium for middle class - it’s just happen to be a bit beyond what most people spend on a side hobby.

Similarly old Sun hardware either you’re screwed with a backward compat issue or again collecting since they are now vintage. x86 doesn’t have the former effect for the most part.

danachow··on The GPU shortage is over
That transistor wear is going to be on a timescale far longer than at issue here - the silicon aging effects referring to will take place over decades of full time for use at low operating temperature - none of these graphics cards are anywhere near that old.
danachow··on The GPU shortage is over
It’s not like this memory use actually causes wear and tear though - DRAM doesn’t involve some irreversible process like Flash does. At the end of the day it is still the same slow thermal death - mining just means the RAM is more prone to overheating than the GPU. And yes it’s hard to know after the fact how the RAM has been treated - but if the RAM is properly cooled it should have no wear just due to use.
danachow··on Logitech MX Products are incompatible with AirPods
> I assume it will accomplish helping the FCC realize that some people are upset about interference in the unlicensed bands

Trust me - they are very well aware of this - and Part 15 is already written with this in mind. No one is surprised that all the junk in the ISM band interferes - as I said elsewhere I think many of us are constantly amazed it works as well as it does.

This is also not enforceable interference - it does not meet the definition of “harmful interference”

> Report the issue as perceived, and give them a chance to surprise you with a useful outcome from that.

My question still remains - what do you think or hope this will accomplish?

Are you hoping they will carve out a slice of new spectrum for AirPods and give it to Apple for free?

> Refusing to report a problem just because (made up example) I think they don't care about Bluetooth

It’s not that they don’t care - it’s that this is getting really outside the scope of their regulations.

You do you, but the point of the federal complaint process is, well …“By filing a consumer complaint and telling your story, you contribute to federal enforcement and consumer protection efforts”

Consumer protection meaning scams and fraud over telecommunication or provision of services - its not a place to vent because your shitty electronics don’t work all the time - which is not fraud even though you may feel cheated. And there are no rules broken to enforce. Having read complaints I know that yours won’t nearly be the dumbest by far but it’s still dumb.

danachow··on Logitech MX Products are incompatible with AirPods
> This is the easiest way to cause the problems listed and would get them in the most trouble.

The devices both run in the 2.4 GHz band so, no, leakage outside the band or even excess power is not the “easiest way” this is causing problems - it’s probably much more mundane.

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