The Gaming Den

Do we have a thread like this yet??

---

So Ess is still in the hospital. The doctors are worried about his blood sugar. It's not budging. No amount of insulin or metformin will bring it down to something normal. Does anyone here know why this would happen?

Obligatory caveat: I am a doctor, but I am not an endocrinologist. There are diabetes specialists who know this material much better than I do.

Insulin works by having glucose absorbed by liver and muscle cells. People who have Type II diabetes are insulin resistant because the number of insulin receptors they express is reduced. If the level of insulin receptors is reduced sufficiently, insulin could show a maximum effect (which would be "no effect at all" if the number of receptors was reduced to zero, obviously). While complete elimination of insulin receptors is highly unlikely, it is easily possible that insulin produced by the pancreas is already enough to saturate whatever insulin receptors exist, making exogenous insulin powerless.

Metformin operates by reducing gluconeogenesis in the liver. Metformin will thus reduce blood glucose levels only to the extent that liver gluconeogenesis is contributing to total blood glucose. If liver gluconeogenesis is a trivial component of current blood glucose levels, then the efficacy of Metformin will be minimal even at high dosages.

Now, obviously the answer to any medical question can be "cancer." Cancer cells can do anything, cause any symptom, express or not express any protein (including modified, non-functional, hyper-functional, or meta-functional proteins), and respond in any conceivable way to any stimulus. However, you can generate the described conditions with regular type II diabetes processes, so that's where I'd start.

You're going to need more tests. You're going to have to check things like Glucagon levels and triglyceride levels. Urinalysis is going to have to check for kidney damage and such. But probably you're going to want to pull out some anti-diabetic drugs that operate on decreasing insulin resistance like a Thiazolidinedione. And/or a major restriction of dietary carbohydrates, possibly combined with a glucose uptake inhibitor like Acarbose.

-Username17

Elaborating on what Frank said about insulin: insulin works by triggering insulin receptors which cause your body to absorb glucose out of the blood and store it in skeletal muscle, fatty tissue, and some other sites. The word 'store' is very important here. You're not removing it from your body, you're not burning it as energy, you're not making it magically disappear. This is a wild oversimplification, but it helps to think of that storage space as finite - you can't just dump your glucose there forever through the use of insulin and expect everything to work out. Eventually those sites stop accepting additional glucose and your insulin receptors stop functioning correctly and you end up with a form of manageable insulin resistance, and you manage it by burning away some of the glucose you have stored (exercise) and controlling your blood glucose on the input end (i.e. dieting) until your body gets some of its insulin sensitivity back. Metformin does a lot of cool things, but nothing that would necessarily fix the situation described above in all cases.

So, yeah. This sounds like a diabetes-related complication. He should probably get tested for diabetes and talk to an endocrinologist/diabetes specialist.

Thank you, guys. The doctors are 99% sure it's diabetes, but since Ess went to the hospital with a huge infection, they weren't 100% sure.

The whole experience has been really strange. We normally eat a pretty low carb diet, so there's a chance that this has been a problem for significantly longer than anyone suspected, and we've been unconsciously managing it for a while.

So, I've got some medical questions. My joints have always been... rather loose; back in highschool I was more flexible than people half my bulk. The problem was that

I seem to have a problem with my joints (or their tissue) being too loose/flexible. Like, carrying some big barbells during a move subluxated my shoulder. Or my fingers folding the wrong way with alarming ease when moving heavy loads.

Every so often the area around the bones in my palms (I forget the name) gets super painful inside, like the bones shifted or something. Usually lasts a day or so regardless of whether its a shoulder, knee, or my hands.

It sort of sounds like a condition I've read about (some people need finger braces, even), but it doesn't sound as severe. Exercise has never really helped me on this, but I do enjoy fitness stuff. Any idea on how to deal with this? I mainly just try to, y'know, not do things that fuck up my shoulders but that isn't always possible.

On a similar note to Meikle, I have cracking joints. My toes, fingers, knuckles, knees, shoulders, elbows, jaw, neck, back, hips and wrists all make popping noises if I flex in a certain way. Is this bad for my health?

Meikle641 wrote:So, I've got some medical questions. My joints have always been... rather loose; back in highschool I was more flexible than people half my bulk. The problem was that

I seem to have a problem with my joints (or their tissue) being too loose/flexible. Like, carrying some big barbells during a move subluxated my shoulder. Or my fingers folding the wrong way with alarming ease when moving heavy loads.

Every so often the area around the bones in my palms (I forget the name) gets super painful inside, like the bones shifted or something. Usually lasts a day or so regardless of whether its a shoulder, knee, or my hands.

It sort of sounds like a condition I've read about (some people need finger braces, even), but it doesn't sound as severe. Exercise has never really helped me on this, but I do enjoy fitness stuff. Any idea on how to deal with this? I mainly just try to, y'know, not do things that fuck up my shoulders but that isn't always possible.

If this were an exam question, I'd pick Ehlers-Danlos Syndrome, Hypermobility Type. There's no cure for that, it just is what it is (a genetic fault with collagen production and deposition). But I'd definitely get an echo cardiogram done if I were you. EDS can be associated with some nasty heart complications and it would be nice to catch those early if they are there.

Grek wrote:On a similar note to Meikle, I have cracking joints. My toes, fingers, knuckles, knees, shoulders, elbows, jaw, neck, back, hips and wrists all make popping noises if I flex in a certain way. Is this bad for my health?

All peoples' joints pop under certain circumstances. Some pop more easily or more loudly than others and it doesn't actually seem to mean anything. We aren't even sure what exactly makes that joint popping sound. Seems like the kind of thing we'd have gotten a good physical model of like two hundred years ago, but no. Louder or more frequent joint popping is not associated with any disease, and the choice to voluntarily pop or not pop your joints appears to make no particular difference.

-Username17

Mm. I do occasionally have an irregular heartbeat, but that's all the Doc's have found.

I sometimes get benign heart palpitations: http://en.wikipedia.org/wiki/Palpitation
Had it checked, I don't have any heart conditions or asthma. It's mostly triggered by stress or when I'm really relaxed but suddenly have to do something physical. But sometimes I'd happen even if I was already regularly exercising, like after I ran a few laps in track, took a rest, then got up quickly and my heartbeat would go up crazy. This was rare though.

It's mostly a tightness around my throat and dizziness. What's a good way to make the palpitations go away faster though, like should I start taking deep breaths, or lie down, or what?

Transient arrhythmias caused by abrupt changes in venous return to the heart are not uncommon. You can avoid them with more gradual warmup and cool down routines, and you can train your heart to stop being such a spazz every time it has to suddenly deal with a higher or lower volume with cardiac exercise.

Anxiety arrhythmias can be avoided with anti-anxiety medication or by calming down in your real life.

-Username17

It seems that I have really, insanely overactive skin bacteria. I'm 26, and have acne about as bad as when I was a teen, as well as frequently developing something like sebaceous cysts on my face, underarms, thighs, or groin.

About a year ago, I developed one of these cysts on the small of my back, went to see a doctor about it, and one that'd been on my thigh for awhile I was waiting for to go away, and he prescribed a sort skin antibiotic, Keflex, I think, which was basically the best acne treatment I've ever used. It cleared up the cysts on my back and thigh, as well as just generally alleviating my acne.

I'm not particularly active, and while I eat a lot, the worst stuff I eat is fast food burgers a couple times a week at most.

Is there anything I can do to get my skin bacteria to calm its tits? I actually use an anti-bacterial shower gel, too, so it seems pretty overactive.

I have myself a mystery lung problem. Throughout the year,but seemingly especially in the winter, I get mucousy chest coughs that seem to be exacerbated by exercise. My only guess for a pattern is that it seems worse when I spend a lot of time in large buildings running central heating. It apparently kicked off one winter when I got a cough so bad I got light-headed for weeks. I repeatedly got an inhaler for bronchitis, which seemed to help the cough but didn't stop it from returning. The cough also causes strangely localized pain in a line straight down the side of my sternum. I've gotten chest X-rays twice but they both came up clean, and the doctor doesn't always hear anything on the stethoscope.

OgreBattle wrote:I sometimes get benign heart palpitations: http://en.wikipedia.org/wiki/Palpitation
Had it checked, I don't have any heart conditions or asthma. It's mostly triggered by stress or when I'm really relaxed but suddenly have to do something physical. But sometimes I'd happen even if I was already regularly exercising, like after I ran a few laps in track, took a rest, then got up quickly and my heartbeat would go up crazy. This was rare though.

It's mostly a tightness around my throat and dizziness. What's a good way to make the palpitations go away faster though, like should I start taking deep breaths, or lie down, or what?

My mom used to be a nurse and taught me this cool trick... She and my brother use it for weird heart palpitations, and I use it for asthma.

Take a deep breath. Hold it for 3 seconds (or however long you can, if you can't get to three). Let it out slowly, and take a few normal breaths. Then repeat a few times.

@Prak:

I had decent success with benzoyl peroxide gel for my facial acne. Don't expect a large reduction soon, but my pustules have an annoying tendency for infection, which has stopped dead completely since I use it.
It's available over the counter here in germany and hardly dangerous compared to OTC cold medication, so I hazard a guess that you'd get it without a prescription in the U.S., too. Given the prices per tube, it's probably not a solution for the rest of your skin. You might want to consult a dermatologist who could prescribe you systemic medication for acne if warranted.
A common side effect of BPO is occasional pricking or piercing pain of the skin you used it on, which can be countered by applying it once every second or third day instead of daily. Applying it to hair can lead to bleaching.



Disclaimer: I'm a medical student halfway through my first (out of four) years of clinical training and studying in germany, so I could very easily be wrong in multiple ways. Generally, if you want to try new OTC medication because someone on the internet suggested it, you should still see a doctor in person if at all possible, even for a minor issue like acne. If that's not possible, check it against all other medication you're taking and any other conditions you have with a qualified pharmacist.

Prak_Anima wrote:It seems that I have really, insanely overactive skin bacteria. I'm 26, and have acne about as bad as when I was a teen, as well as frequently developing something like sebaceous cysts on my face, underarms, thighs, or groin.

About a year ago, I developed one of these cysts on the small of my back, went to see a doctor about it, and one that'd been on my thigh for awhile I was waiting for to go away, and he prescribed a sort skin antibiotic, Keflex, I think, which was basically the best acne treatment I've ever used. It cleared up the cysts on my back and thigh, as well as just generally alleviating my acne.

I'm not particularly active, and while I eat a lot, the worst stuff I eat is fast food burgers a couple times a week at most.

Is there anything I can do to get my skin bacteria to calm its tits? I actually use an anti-bacterial shower gel, too, so it seems pretty overactive.

Acne is essentially a three part process. Hair follicles are partially or fully blocked by keratin, sebaceous glands over produce sebum and create a cyst, and that cyst gets colonized by bacteria and forms an infected abscess. So methods to go after acne really start from the standpoint of addressing one of those three. Vitamin A derivatives can help clear keratin from follicles, and antibiotics can kill bacteria. Sebum accumulation is more complex, as you can essentially reduce the amount you create (by being less stressed and consuming less fat), or you can get the sebum to come out of your pores (by exercising more or washing it out).

name here wrote:I have myself a mystery lung problem. Throughout the year,but seemingly especially in the winter, I get mucousy chest coughs that seem to be exacerbated by exercise. My only guess for a pattern is that it seems worse when I spend a lot of time in large buildings running central heating. It apparently kicked off one winter when I got a cough so bad I got light-headed for weeks. I repeatedly got an inhaler for bronchitis, which seemed to help the cough but didn't stop it from returning. The cough also causes strangely localized pain in a line straight down the side of my sternum. I've gotten chest X-rays twice but they both came up clean, and the doctor doesn't always hear anything on the stethoscope.

Well, superficially, getting respiratory exacerbations when you are exposed to relatively cold air (as when you step out of a building that has central heating) or during exercise is pretty typical for asthma. Airway management for asthma is pretty important, as the inflammation can do longterm damage. If you aren't getting complete control with periodic inhalers, you should consider getting yourself a long term control drug (those are usually also inhaled, for obvious reasons, but taken on a daily basis rather than sporadically).

-Username17

Maj wrote:

OgreBattle wrote:I sometimes get benign heart palpitations: http://en.wikipedia.org/wiki/Palpitation
Had it checked, I don't have any heart conditions or asthma. It's mostly triggered by stress or when I'm really relaxed but suddenly have to do something physical. But sometimes I'd happen even if I was already regularly exercising, like after I ran a few laps in track, took a rest, then got up quickly and my heartbeat would go up crazy. This was rare though.

It's mostly a tightness around my throat and dizziness. What's a good way to make the palpitations go away faster though, like should I start taking deep breaths, or lie down, or what?

My mom used to be a nurse and taught me this cool trick... She and my brother use it for weird heart palpitations, and I use it for asthma.

Take a deep breath. Hold it for 3 seconds (or however long you can, if you can't get to three). Let it out slowly, and take a few normal breaths. Then repeat a few times.

THIS ONE WEIRD TRICK DISCOVERED BY A MOM CURES ASTHMA

Chamomile wrote:THIS ONE WEIRD TRICK DISCOVERED BY A MOM CURES ASTHMA

Well, she learned it in nursing school and it doesn't cure asthma, just helps get minor spasms under control so... Not sure what you were trying to go for here.

I think he was remarking on how that sentence it reads a bit like a lot of internet ads. For instance, for a while when I check one of my email accounts I would see an add that read something like This one weird trick to save ### on car insurance.

I also see ads that say something about this "one weird trick" to lose belly fat.

Oh..... it's actually a meme now.

http://www.slate.com/articles/business/ ... ingle.html

Maj wrote:

Chamomile wrote:THIS ONE WEIRD TRICK DISCOVERED BY A MOM CURES ASTHMA

Do doctors hate you now?

The valsalva maneuver, where you breathe in, breath out against a closed glottis (so that no air actually escapes, but the intrathoracic pressure is raised) is actually standard procedure in boring academic medicine, so I doubt this trick would provoke much hate from doctors. We used the maneuver in anatomy class to get a good look at our own external jugular veins, but it can have an effect on a subset of tachycardias.

Even if you don't breath out against a closed glottis, deep inspiration always increases your heart rate by a small margin (because the negative thoracic pressure increases venous return), while exspiration decreases it. I suppose it could have a similar effect to valsalva by forcing a change on the heart rhythm.

I'd suggest having a comfortable chair nearby when you try it, it always makes me a little dizzy.

(Edited for more physiology)

Oh! Yeah, I've seen those. I used the word trick because I never remember the actual name. I want to call it Veblen or Van der Graaf, because I think it starts with a V, but those are definitely not right.

And no. Doctors don't hate me now (I tried! Really I did!). In fact, Ess' doc at the hospital said she wanted to go home with us.



Edit: It's Valsalva! Thank you. I never remember.

Valsalva-ing also really helps me when I lift, for what it's worth.

I recently got prescribed Adderall, and I have to say, it's been working wonders. I know psychiatric drugs are really hard to predict, but if I'm taking it every/most days should I begin to notice increasing tolerance after a certain specific amount of time?

Tolerance to amphetamines builds up in most users pretty quickly, but the exact rates are extremely variable. I'm not really a fan of gradually increasing the dosage indefinitely, as that ends up really screwing people's dopamine levels. Adderall withdrawal lasts about 3 weeks plus whatever you've done to your brain's dopamine.

-Username17

From personal experience, I recommend being very stingy with your use of Adderall. It's a big tradeoff between now and later.

Can you elaborate on that, YLM?