u/mtmuelle

The definition of mild anemia is hgb 10-12. Moderate is 8-10. Severe is less than 8. Calling it mild anemia is just the definition of it.

<10% of the time fatigue is from anemia.

Your ferritin is low.

Your fatigue could be from anemia or iron deficiency, but don't abandon other possibilities that are much more common.

every time I order a urine drug screen, I always find multitudes of deficiencies, usually 10+. I'm not really sure what these other doctors are doing for it to get this bad, but I replete them all ASAP. It's gotten so bad I just order a urine drug screen on everyone.

Never disagreed with that, but most people regain their weight after losing it because they fail to take into account that your basal metabolic rate will decrease in an effort to regain your weight in what your body interprets as a temporary period of starvation

If a person's only plan is to go on a diet and eat less calories, they'll have a 5-20% success rate 1-5 years later. There is a lot of nuance to weight loss that people ignore.

Losing out on the AC heroes would be a huge blow. Save summons for the halloween and christmas banners. You have many desirable heroes and restarting would not help you. Most of the best heroes are from ancients or limited. Even if you could choose your first 5 starting non-limited legendaries, it wouldn't be worth it.

Don't sleep on epics early game, the good epics at a5 are comparable or better to many a0 legendaries

People might think fastidious is cringe, but watching 20 minute videos of someone you think is cringe and making reddit threads about it is 10x more cringe

Whales buy nearly every bundle.

Spenders buy the privilege card + 3 monthly deals + the 2 passes + maybe some good summoning deals. That is also roughly the order of most worth to least worth

F2p or near f2p buy the privilege card

Do a ton of campaign and you'll get plenty of summons for sun wukong and ideally you can pity manipulate to get a banner hero

Just look at her BP in the screenshot, that's all you need to know. She carried me through most of the campaign and is good in all the aoe scenarios

One of my patients today told me that she can feel decreased bloodflow to her bowels whenever she hasn't had her doxazosin in 5 hours and she can feel the adrenal gland release in her head every night at 3-4am. She further stated that without the correct alpha and beta blockade, it gives her a weird sensation like she wants to die. Also every other sentence she was concerned about her high blood pressure when her numbers in the clinic were always in the 110s. I tried multiple times to explain that pain or abnormal symptoms can temporarily spike her BP and that her BP in the 130s wasn't causing decreased blood flow to the bowels and it just fell on deaf ears.

I really wonder how a LLM would have interpreted that encounter

they do it for the gram, not because they're actually studying

Two can play at that game

"I'm prescribing you an antioxidant that will relax and lower the overall stress levels of the blood vessels to calm nerve impulses"

*Prescribes carvedilol*

So aging isn't common? You're cherry picking very certain words.

My main argument is that untreated hashimotos contributes to weight gain and people keep using "kcal in, kcal out" as a "got you", not looking at the 3rd and 4th words of that sentence.

The evidence is robust? What studies? There is like a 1-2% decrease in basal metabolic rate per decade, hypothyroidism can decrease it by 200-400 kcals if untreated which can cause a 20-40 lb weight gain in a year without dietary changes, pregancy drastically changes it, recent weight gain or weight loss can change it by a few hundred as well.

Although it doesn't seem like much, humans do not live for only a few weeks. Even a 1% change is significant and adds up over a year and especially a decade.

Although not as easily modifiable as diet, if you were also to give someone advice of modifiable risk factors to increase their basal metabolic rate by 100 kcals, that would be a 10 lb weight loss over a year without any dietary changes.

Also, to your earlier comment about GLP1s so people are not misinformed, although GLP-1's main mechanism invovles a decreased appetite, they also slow gastric emptying and suppress glucagon secretion as part of the mechanism which is also just not as simple as kcal in, kcal out. Suppressing the diet is not an easy thing to do as well, the control groups in the glp1 trials were given dietary counseling and physical activity guidance. So telling people that the glp1's main function can be easily achieved with diet is misleading, as mounjaro showed a 15-21% weight loss of their entire body weight over those who received the same counseling you are giving.

I think you have me confused for user mjjacks.

He initially told you that endocrine disorders cannot violate [kcal in, kcal out] to which I responded that untreated hypothyrodism is the second part of that which has the implication that if you treat that, it helps with weight loss

As for the semantics of the word common, the basal metabolic rate for everyone is dynamic and will change with age, fevers, pregnancy, weight loss/gain, etc. So those are pretty common, even if you don't have control over a lot of it.

There are a few things that can change calories out.. one of them is hypothyroidism. Another common one is that the basal metabolic rate will change for people based on what their weight was about 6 months ago to maintain and stabilize their weight which is why weight loss medications are still prescribed for about 6 months after a person reached their goal weight.

You keep typing "calories in calories out" but you don't at the second half of your formula

That is not at all what I said. Drastically changing the calories out makes it much harder to lose weight.

"Endocrine disorders cannot violate the basic laws of the universe"

*Untreated* Hashimotos or hypothyroidism can decrease your metabolism and therefore decrease your basal energy expenditure throughout the day making it harder to lose weight. That's not defying thermodynamics, but untreated hypothyroidism causing weight gain is a real thing and it's not as simple as cutting calories when your body is also cutting how much it expends.

and what you mentioned are kickbacks.. which doctors do not receive in any way, shape, or form for any medication prescribed, test ordered, etc.

Wait until you find out that you and 99% of other physicians in your area are ordering less bone marrow biopsies than the average physician in your area and that he's ordering more than everyone else combined

Plot twist: this guy actually just really hates his liver and kidneys

180 implies that you've already done 180 summons, not 180 to go. I would only do guarantees with ancient summons. If you just yolo'd your 52 ancients and then on halloween they run a banner that guarantees a good hero at 90, you'd regret it. But also now that I think about it more, the only time they've done that is for the AC collab as far as I know and they wouldn't have a new collab in 2 weeks without telling us so maybe christmas will have the new collab

at the end of the day it's all a gamble, but I'd save up for new infernal lord, see if there's an oren banner, or a new collab banner

you're very unlikely to hit a nastya with the amount of ancients you've been able to save up. In the AC collab they guaranteed a hero at 90 ancients that didn't use up your pity and if they run a similar banner on halloween that would be your best bet, but it's a gamble.

If that isn't on halloween, the second best scenario is probably pulling for the new infernal lord whenever that comes out later this year or an oren banner if that comes up

"I don't know how I'm gaining weight, all I eat every day is one meal which is a small salad with no dressing"

I know you're lying. I eat 15x that and I'm 25% of your weight

People count 5 minutes of walking every day as their exercise and then wonder why they get tired climbing stairs.

To be honest, I thought art, acting, driving, making videos, and music would be the very last ones to go to AI but AI has shown it can do all of that so I am going to take a leap and say that AI may assist with procedures faster than we think: procedures are stepwise and if a surgeon gets to where it needs to be done, it can be performed with little to no patient interaction: clamp, clamp, cut, move, suture, etc

Hey, 0.12 seconds into the first episode here, please don't spoil anything for me, why has nothing interesting happened yet??