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Addiction LXXVII

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Road Cycling “It is by riding a bicycle that you learn the contours of a country best, since you have to sweat up the hills and coast down them. Thus you remember them as they actually are, while in a motor car only a high hill impresses you, and you have no such accurate remembrance of country you have driven through as you gain by riding a bicycle.” -- Ernest Hemingway

Addiction LXXVII

Old 03-19-20, 06:50 AM
  #9351  
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On the possibility of computer games, has anyone played EVE? I watched one of those YouTube commercials about it the other day and it looks intriguing. Any thoughts from anyone?
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Everyone thinks they have had a long strange trip, until they look at other folks' journeys. Then they realize everyone has had a long strange trip, just using different modes of transportation.
"The mystery of life isn't a problem to solve, but a reality to experience."
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Old 03-19-20, 07:16 AM
  #9352  
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Originally Posted by Jadesfire View Post
On the possibility of computer games, has anyone played EVE? I watched one of those YouTube commercials about it the other day and it looks intriguing. Any thoughts from anyone?
Haven't played it, but one of my old friends got really in to it. The complexity and openness looks pretty remarkable. EVE stories make my Google new feed every once in a while, and within the last week, I heard about a guy transporting his long accumulated treasure trove. Some pirates caught wind and destroyed his vessel, costing him the equivalent of $5k real world dollars, iirc.
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Old 03-19-20, 07:17 AM
  #9353  
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He's feeling better but was pretty worried for a while
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Old 03-19-20, 07:17 AM
  #9354  
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Originally Posted by datlas View Post
I noticed a very interesting trend in office visits comparing my office and a sister office a few towns over.

My office is in a college town/county seat, and most patients are college educated/white collar. The sister office is in a post-industrial town (the steel mills are all shut down) and more blue-collar.

Our patients are generally NOT wanting to come in for regular visits, more than half are cancelled. And the patients who are sick don't want to come in and want us to diagnose/treat over the phone. We are seeing VERY few patients in the office.

The sister practice is still quite busy, patients are coming in for physicals/routine office visits and sick visits too. I am guessing that it's a demographic issue. It's good for the sister office economically, but maybe not so good for their population as a whole.

I am trying to convince the majority of my patients to do telehealth visits whenever possible. If in-person necessary (like say a physical) I am willing to see those patients now but also fine to postpone routine annual physicals a few months. I am leaving that decision up to the patients (for now).
We are trying to limit our cases to urgent and emergency things only, but our clients can’t distinguish.

Yesterday I saw a blind Pug as an “urgent” case. The dog had lost her vision over about 6 weeks until she went completely blind around 3 weeks ago. From her neurologic exam, the problem could have either been with the retinas (in which case she needs an ophthalmologist) or the optic nerves (in which case she needs to see me).

Questioning the owner further, she already saw an ophthalmologist who “did some test where they put her in a dark room and flashed laser beams into her eyes and then the machine spit out a graph.” Not laser beams but that would be an ERG, the test which would tell us whether it’s a retinal problem or not. What did the test show? “I don’t know”. What did the ophthalmologist tell you? “I don’t remember.”

Jeez so I call the ophthalmologist who is excellent and I know personally and who not only would never fail to explain a diagnosis to a client but who would always also provide a written summary. She’s in surgery but gets on speaker phone to talk to me- flatline ERG, definite retinal disease, weird diagnosis that she spent 3 hours discussing with the owner, zero idea how this owner got the idea that there’s an urgent need to see a neurologist.

On Monday I saw an “urgent” probable diabetic neuropathy in a 19 year old cat who I kid you not has had nothing more than a single spot blood glucose in a year and a half, and that was 450 mg/dL six weeks ago. Go back to the prescriber of your insulin and get a glucose curve please.

So this will be our problem in trying to limit our caseload at all. We can’t tell over the phone- sudden blindness from neurologic causes would indeed be a life threatening emergency, whereas already-diagnosed ophthalmologic blindness is not. Incoordinated gait and trouble walking would be an urgent problem, but we’re not likely to do much with that in a poorly regulated diabetic until someone at least makes a stab at figuring that out and correcting it.

The vet school at Univ of Wisconsin has shut their hospital down completely because someone who works there was dx with COVID19.
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Old 03-19-20, 07:18 AM
  #9355  
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I have solitaire on my phone.
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Amateur bike racing is just a fun thing, as far as I know, there's no penalty for not winning.
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Old 03-19-20, 07:25 AM
  #9356  
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Originally Posted by BillyD View Post
Very interesting. Gives new meaning to the phrase “A mind is a terrible thing to waste “.
Im not really sure what this means.

But: the white collar people have gotten the correct message regarding avoiding contact with others right now.

The blue collar people are doing it wrong- going in for your annual physical right now is the wrong thing to do, to the extent that I’m surprised the sister practice is playing along with this.

Sick people going to the doctor makes sense. So does calling to see if you can be diagnosed/treated over the phone (that’s what telemedicine is), and then going in if you can’t. Well people going to the doctor right now makes no sense.
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Old 03-19-20, 07:32 AM
  #9357  
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Originally Posted by datlas View Post
After the last two days' rides, I should probably make a "David Letterman Top Ten List" of hazards on the MUP:

10. Leaves/debris
9. Walkers in their own world
8. Cars not honoring the "stop for people on trail" rule at road crossings (of which there are many)
7. Little kids walking ahead of their parents and turning around to see where they are
6. Entire family of adults/kids on bikes, weaving all around
5. Kids on bikes, oblivious to what's around them
4. Kids on razor scooters
3. Runners with earmuff headphones who can't hear me yelling "rider coming through" and almost run into me
2. Recreational cyclists who randomly stop in middle of trail
1. "Serious" Tri-geeks zooming on the trail in the full aero position and buzzing everyone

I have learned to yell "CYCLIST COMING THROUGH" which I think makes more sense than "ON YOUR LEFT!" to most people. I also mentally note anytime I see a hazard, slow down, and choose an alternate evasive maneuver trajectory to use if needed. I wonder if I should get a bell for my trail bike.

What bell is best for bullhorn bars??
MUP's are extremely hazardous. I recall when I first got back on pavement after ACL surgery. It was nearly winter, so I figured an easy ride on the lightly populated MUP would be great to keep me away from cars and such. After half an hour of avoiding dogs, joggers, people taking the full lane with side by side strollers, and rude cyclists going for KOP's, I decided I'd rather take my chances playing in traffic.
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Old 03-19-20, 07:43 AM
  #9358  
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Originally Posted by Heathpack View Post
We are trying to limit our cases to urgent and emergency things only, but our clients can’t distinguish.

Yesterday I saw a blind Pug as an “urgent” case. The dog had lost her vision over about 6 weeks until she went completely blind around 3 weeks ago. From her neurologic exam, the problem could have either been with the retinas (in which case she needs an ophthalmologist) or the optic nerves (in which case she needs to see me).

Questioning the owner further, she already saw an ophthalmologist who “did some test where they put her in a dark room and flashed laser beams into her eyes and then the machine spit out a graph.” Not laser beams but that would be an ERG, the test which would tell us whether it’s a retinal problem or not. What did the test show? “I don’t know”. What did the ophthalmologist tell you? “I don’t remember.”

Jeez so I call the ophthalmologist who is excellent and I know personally and who not only would never fail to explain a diagnosis to a client but who would always also provide a written summary. She’s in surgery but gets on speaker phone to talk to me- flatline ERG, definite retinal disease, weird diagnosis that she spent 3 hours discussing with the owner, zero idea how this owner got the idea that there’s an urgent need to see a neurologist.

On Monday I saw an “urgent” probable diabetic neuropathy in a 19 year old cat who I kid you not has had nothing more than a single spot blood glucose in a year and a half, and that was 450 mg/dL six weeks ago. Go back to the prescriber of your insulin and get a glucose curve please.

So this will be our problem in trying to limit our caseload at all. We can’t tell over the phone- sudden blindness from neurologic causes would indeed be a life threatening emergency, whereas already-diagnosed ophthalmologic blindness is not. Incoordinated gait and trouble walking would be an urgent problem, but we’re not likely to do much with that in a poorly regulated diabetic until someone at least makes a stab at figuring that out and correcting it.

The vet school at Univ of Wisconsin has shut their hospital down completely because someone who works there was dx with COVID19.
What waste of time. Our local consult services have been given permission to defer exams and simply give phone advice in order to cut down on the strain on skeleton crews and protect clinicians.

We just had consult rounds by video conference with a huge turnout—I guess people are lonely at home. HIV positive guy with bad teeth and multiple hemorrhagic, ring-enhancing, lesions. Needle biopsy of brainstem lesion showed mycobacterium avium intracellulare. I don't know if I've ever seen an MAI brain abscess, but the surgeon said he saw a few before good antiretroviral treatment. Could it have come from the teeth? Pretty unusual.

Radiologist had to point his laptop camera at his PACS screen and anytime anyone else talked, the image switched to them.

Oh, and Hopkins wimped out on the biopsy. Our surgeon was, like "Aw shucks, you can biopsy anything with a needle."

Other funny thing was his coronavirus PCR came back positive with big scare capitals. Then they followed up and said it was another strain.

Last edited by MoAlpha; 03-19-20 at 07:51 AM.
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Old 03-19-20, 07:48 AM
  #9359  
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Originally Posted by datlas View Post
1. "Serious" Tri-geeks zooming on the trail in the full aero position and buzzing everyone
Bugs the hell out me probably most of all, especially on the wider parts of the SRT. What if a groundhog or rabbit comes out of the grass just as you are buzzing me and I have to move left quickly? I am a big guy. It's likely not going to end well for you, especially in I am riding my LHT. Simple physics.
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Old 03-19-20, 08:00 AM
  #9360  
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Originally Posted by WalksOn2Wheels View Post
MUP's are extremely hazardous. I recall when I first got back on pavement after ACL surgery. It was nearly winter, so I figured an easy ride on the lightly populated MUP would be great to keep me away from cars and such. After half an hour of avoiding dogs, joggers, people taking the full lane with side by side strollers, and rude cyclists going for KOP's, I decided I'd rather take my chances playing in traffic.
Looks like Denton has a lot more MUP options than when I lived there in 2009-2012.

I don't remember the Denton-Katy trail being there, but maybe it was.
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Old 03-19-20, 08:00 AM
  #9361  
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Originally Posted by Trsnrtr View Post
Never seen an episode, today may be the day.

One of my favorites was the first season of "True Detective" with Woody Harrelson and Matthew McConaughey. Totally freaked me out.

Edit: Just looked up "The Wire" on IMDB and it has a rating of 9.3/10. That has to be worth something.
Sopranos was good, Breaking Bad was better, and The Wire is on equal footing with Breaking Bad, just different.
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Originally Posted by Bah Humbug View Post
In other news, to effect quick passes of other cyclists out this morning, I did dial it up to 400w to pass several times. It doesn't actually feel like much of anything for that duration. Not sure what that guy was on about.
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Old 03-19-20, 08:00 AM
  #9362  
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Originally Posted by MoAlpha View Post
What waste of time. Our local consult services have been given permission to defer exams and simply give phone advice in order to cut down on the strain on skeleton crews and protect clinicians.

We just had consult rounds by video conference with a huge turnout—I guess people are lonely at home. HIV positive guy with bad teeth and multiple hemorrhagic, ring-enhancing, lesions. Needle biopsy of brainstem lesion showed mycobacterium avium intracellulare. I don't know if I've ever seen an MAI brain abscess, but the surgeon said he saw a few before good antiretroviral treatment. Could it have come from the teeth? Pretty unusual.

Radiologist had to point his laptop camera at his PACS screen and anytime anyone else talked, the image switched to them.
Sadly it’s doesnt really work like that in vet med. Most GP vets are excellent and responsible and wouldn’t refer a case like those two. But some just completely become unable to think or apply logic/common sense if there’s any neurologic component to the case, they just throw up their hands and refer it. Those vets would not be interested in a video conference because they don’t want any further role in caring for that animal. The vets who *would* be interested in the video conference rounds wouldn’t refer cases like those two.

The old school ethic of being a vet specialist was that you were one of the lucky ones who got advanced training and your obligation was always to help GP vets for free. This ethic has dissipated somewhat but still pretty much any GP vet can call any specialist vet to get free consultation of their case and help with managing it. I used to do this tons, and it’s to my benefit because my referring vets get better at Neuro and I get better referrals.

But modern vet medicine has become about throughput and spending a lot of time consulting with a specialist is less time efficient for GP vets than making a referral. It’s a shame because that GP vet could learn a lot doing the free consult with me and at least trying to manage the case, and then he or she would get better at Neuro over time and improve their practice of vet med. But like all things, you’ve got to be willing to put the time into it to get better, and not everyone cares to do that.
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Old 03-19-20, 08:15 AM
  #9363  
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Originally Posted by Heathpack View Post
Sadly it’s doesnt really work like that in vet med. Most GP vets are excellent and responsible and wouldn’t refer a case like those two. But some just completely become unable to think or apply logic/common sense if there’s any neurologic component to the case, they just throw up their hands and refer it. Those vets would not be interested in a video conference because they don’t want any further role in caring for that animal. The vets who *would* be interested in the video conference rounds wouldn’t refer cases like those two.

The old school ethic of being a vet specialist was that you were one of the lucky ones who got advanced training and your obligation was always to help GP vets for free. This ethic has dissipated somewhat but still pretty much any GP vet can call any specialist vet to get free consultation of their case and help with managing it. I used to do this tons, and it’s to my benefit because my referring vets get better at Neuro and I get better referrals.

But modern vet medicine has become about throughput and spending a lot of time consulting with a specialist is less time efficient for GP vets than making a referral. It’s a shame because that GP vet could learn a lot doing the free consult with me and at least trying to manage the case, and then he or she would get better at Neuro over time and improve their practice of vet med. But like all things, you’ve got to be willing to put the time into it to get better, and not everyone cares to do that.
Everyone here is a hyper-specialist and focused on their own protocols, which means lots of learned incompetence too. We get a lot of "please examine my patient for me," "rule out all neurological abnormalities," and "ICU patient hasn't moved their right side for three days, think we should get an MRI?"
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Old 03-19-20, 08:39 AM
  #9364  
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Originally Posted by datlas View Post
I know that CDC says that suspected or confirmed COVID19 patients are allowed to lift self-quarantine/isolation if it's been over 7 days since they got symptoms and have been afebrile for 72 hours without antipyretics.
wut
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Old 03-19-20, 08:39 AM
  #9365  
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Originally Posted by datlas View Post
I know that CDC says that suspected or confirmed COVID19 patients are allowed to lift self-quarantine/isolation if it's been over 7 days since they got symptoms and have been afebrile for 72 hours without antipyretics.

Your case is different so check with your people.
Of course we all know what that means
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Old 03-19-20, 08:41 AM
  #9366  
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Originally Posted by Jadesfire View Post
On the possibility of computer games, has anyone played EVE?
Every now and then I try MS Minesweeper. I have never solved the difficult puzzle within the allotted time.
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Old 03-19-20, 08:49 AM
  #9367  
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Originally Posted by MoAlpha View Post
Everyone here is a hyper-specialist and focused on their own protocols, which means lots of learned incompetence too. We get a lot of "please examine my patient for me," "rule out all neurological abnormalities," and "ICU patient hasn't moved their right side for three days, think we should get an MRI?"
Lol the dreaded “I need a Neuro consult!”

Ok what did you find on your exam?

“I haven’t done one”

Ok what’s the history?

”I haven’t talked to the owner yet”

The thing I get a lot of is “my patient needs an MRI!”

Yes in a perfect world, your patient does need an MRI. But to do that, he needs general anesthesia and he’s in renal failure and heart failure so not only is anesthesia contraindicated but overall prognosis is bleak. How about you have that conversation with the owner before we schedule the MRI?

Everyday I drive home the message that expensive tests/procedures that have risk to the patient should only be performed because they are going to make a difference for the care of that patient. Not because you looked in a book and read that’s the way to diagnose symptom X.

Lol I might drive this home everyday but everyday I get someone suggesting we do an expensive risky thing with a patient that will make no difference to that patients outcome, mostly for lack of big picture thinking. So I must not be a very good teacher.
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Old 03-19-20, 08:52 AM
  #9368  
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Last computer game I messed with was MYST. It cured me Some of us just don't have that kind of brain.
in other news, I will wait until 9:00 and go pay the car insurance bill and then (finally) go for a ride.
Who knows, maybe I'll complete that months old wheelbuild. I finally got spokes for the front. Straight gage (stainless) steel, with, prolly, steel nipples. How long do they have to last, really?
And, at some point I have to start in on the headshock overhaul. I brought two of them home from the office, figuring that if I'm successful with the first, the second will still be fresh.

Last edited by seedsbelize; 03-19-20 at 08:58 AM.
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Old 03-19-20, 09:04 AM
  #9369  
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In still other news, this self-quarantine thing is really no big deal for me. It's the way I tend to live my life anyway. I do have compassion for those suffering it. My long suffering wife, for example
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Old 03-19-20, 09:04 AM
  #9370  
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Originally Posted by Velo Vol View Post
Every now and then I try MS Minesweeper. I have never solved the difficult puzzle within the allotted time.
Damn Windows 10 and no Minesweeper or even Solitaire without ads.
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Originally Posted by LAJ View Post
Everyone thinks they have had a long strange trip, until they look at other folks' journeys. Then they realize everyone has had a long strange trip, just using different modes of transportation.
"The mystery of life isn't a problem to solve, but a reality to experience."
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Old 03-19-20, 09:06 AM
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Originally Posted by WhyFi View Post
Haven't played it, but one of my old friends got really in to it. The complexity and openness looks pretty remarkable. EVE stories make my Google new feed every once in a while, and within the last week, I heard about a guy transporting his long accumulated treasure trove. Some pirates caught wind and destroyed his vessel, costing him the equivalent of $5k real world dollars, iirc.
The ad reminded me of the descriptions in Ender's Game of the space battles. I think I'd need a new computer to play it, though.
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Originally Posted by LAJ View Post
Everyone thinks they have had a long strange trip, until they look at other folks' journeys. Then they realize everyone has had a long strange trip, just using different modes of transportation.
"The mystery of life isn't a problem to solve, but a reality to experience."
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Old 03-19-20, 09:13 AM
  #9372  
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Originally Posted by Jadesfire View Post
Damn Windows 10 and no Minesweeper or even Solitaire without ads.
I also have compassion for those of you still saddled with Windows. Ads in solitaire is unimaginable. In my little kona of the world, I'm full Android, with Brave on my phone. No ads ever. No Google feed anymore. Liberation!
Of course I don't have solitaire either. Some things we just learn to live without. I was getting quite good at Freecell

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Old 03-19-20, 09:17 AM
  #9373  
WalksOn2Wheels
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Originally Posted by abshipp View Post
Looks like Denton has a lot more MUP options than when I lived there in 2009-2012.

I don't remember the Denton-Katy trail being there, but maybe it was.
I was actually in Arlington, TX at the time riding at River Legacy on the north side of town.

I think the Denton-Katy trail was mostly a by product of the rail line being put in to join up with the DART rail line. I forget why, but some sort of dispute thing meant someone didn't any DART through their town, but Denton building one was ok? Maybe a county line thing? Anyway, supposedly you can ride all the way to lake Lewsiville. Maybe I'll give it a shot one day. Plenty of strong southern winds to push me back home.

They have been building more MUP's near me, which is mostly awesome just because it cuts around tricky traffic section to make it easier to get out of town. There is even one right behind my house.
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Old 03-19-20, 09:34 AM
  #9374  
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Originally Posted by seedsbelize View Post
I also have compassion for those of you still saddled with Windows. Ads in solitaire is unimaginable. In my little kona of the world, I'm full Android, with Brave on my phone. No ads ever. No Google feed anymore. Liberation!
Of course I don't have solitaire either. Some things we just learn to live without. I was getting quite good at Freecell
I mean, I've got a deck of cards... I'm not wandering through my existence without the ability to play Solitaire. But I am a little bummed that I can't play Minesweeper (at least not without a larger budget and some pretty hefty consequences).
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Old 03-19-20, 09:35 AM
  #9375  
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Originally Posted by WalksOn2Wheels View Post
I was actually in Arlington, TX at the time riding at River Legacy on the north side of town.

I think the Denton-Katy trail was mostly a by product of the rail line being put in to join up with the DART rail line. I forget why, but some sort of dispute thing meant someone didn't any DART through their town, but Denton building one was ok? Maybe a county line thing? Anyway, supposedly you can ride all the way to lake Lewsiville. Maybe I'll give it a shot one day. Plenty of strong southern winds to push me back home.

They have been building more MUP's near me, which is mostly awesome just because it cuts around tricky traffic section to make it easier to get out of town. There is even one right behind my house.
That makes sense, I left just as the train station was getting finished.

Also, my sense of scale is way off. Apparently the Denton-Katy is only 12 miles long. I swear it was farther than that from Denton to Lewisville.
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