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I’m a doc (radiology) and I…

I’m a doc (radiology) and I do these kinds of injections under image-guidance, both in the spine and joints. The vast majority of people tolerate these procedures very well. There is a subset of people who seem to have a psychogenic component to their pain who don’t do well during the procedure or respond particularly well either (I’ve never been able to figure out if these people have pain because they’re “crazy” or are “crazy” because they have pain…but you can usually intuitively identify them as soon as you walk in the room). 

Anyway, it seems like roughly 1/3 of people don’t get much relief, 1/3 of people get a few weeks or a few months, and 1/3 of people are “cured.” This is anecdotal as I don’t really have patients of my own (I’m just the guy with a camera and a needle) and I don’t get much formal follow up or feedback. 

One thing I wanted to note (and my main reason for posting): as you might infer from the story here, it can be hard to localize the source of nerve-related  symptoms. The body doesn’t do a great job of differentiating the source of pain. This is particularly true in the low back/pelvis/hip, but elsewhere too. Is it a pinched lumbar nerve? Is it SI joint pain? Is it mechanical hip pain? An often overlooked component of these injections is that they perform both a therapeutic AND diagnostic function.

The therapeutic part is: “this might make take away the pain for a period of time.”

The diagnostic part is: you had pain. I delivered a dose of short-acting anesthetic (basically lidocaine) and a steroid at a specific location (for example, the left L5 nerve root or the right SI joint). Even if the steroid isn’t able to “cure” the nerve/joint irritation, if the source of the pain is indeed this specific nerve root or joint, then the “lidocaine” should knock that pain out for a day or whatever. So even if you only have a few hours of relief, that can be valuable info for the orthopod or neurosurgeon in terms of targeting any subsequent surgical options. I always tell my patients to pay close attention to their symptoms after getting the shot and to communicate them to the surgery folks when they follow up. I am reluctant to do multiple injections at one time for this reason: if I treat the L3, L4, and L5 nerve roots at once then the diagnostic value is lost (but there are situations where it is totally reasonable to do multiple injections).

For the record, I haven’t…

For the record, I haven’t done a careful rewatch. I think your’s is a totally reasonable interpretation, but I think that, if you were so inclined, you could also make the argument that everything that happened in the show’s world (whether or not Nora is lying to Kevin and/or herself) was real. That duality is why I think the finale is so interesting. Again, it comes down to what the viewer wants to believe. The show very purposefully left it open-ended. You know, the whole “let the mystery be” thing.

I think it’s weird to…

I think it’s weird to compare these two shows. I enjoyed the hell out of both of them, but GoT was pure spectacle and BB had things to say.

I always think about novels as fiction versus literature. Both can be enjoyable but the latter has a purpose beyond pure entertainment. GoT is fiction, BB is literature. 

I guess I can see the similarity in that BB and the first several seasons of GoT were deservedly lauded for the intricacy of their plotting.

Six Feet Under was great. 

Six Feet Under was great. 

Breaking Bad is a top 5 all-time show for me and the finale was great, but it was my third or fourth favorite episode of that season.

Under-the-radar pick: Angel.

The last season of “The Leftovers” destroyed me. Vague spoilers alert (!!!) but I think a lot of people didn’t “get” the finale. Nora’s whole explanation of why she ghosted is completely up to the audience to believe or not. The whole show was about faith and belief and that the truth about the unknowable is simply what you choose to believe (or something kinda along those lines). I thought that show was wildly underappreciated (at least the second and third season; the first was often brutally hard to watch and I get why people gave up on it).

I hear sex panther works

I hear sex panther works “most likely never...anytime soon.”

It's my understanding that

It's my understanding that there's a lot more money in basketball endorsements than football (at least when it comes to the shoe companies). I'm sure there's is shady money in football recruiting too, but it seems like there's a lot more predictability in prognosticating basketball endorsements (less time passes for the one-and-dones BB guys, less injuries, greater individual recognition, etc.).

I don think so...

As I understand it (and I could very well be wrong), Pitino is entitled to the 44 million dollars left on his contract unless it can be shown he definitively violated it. I don't think he'll be too eager to admit anything.

Umm...

I think Kaepernick waives the flag too.

Yes x 1000

She was an amazing teacher and all around cool woman. Presumably still is. Loved her little chemical equation tattoo. I was hemorrhaging cash waiting tables while getting my masters when she sat in my section. We got to chatting and she hired me as an Orgo and biochem GSI on the spot. Probably saved me $60,000 after factoring in loan interest. Best job I ever had.

Parking structures

I work at a big employer where pretty much everyone starts at 7, so it's always a clusterfuck trying to park in the morning: long lines of cars snaking up and down the narrow aisles.



Pet peeves:

1. The asshole who has to laboriously back into his spot while 74 people wait behind him (so that he can peel out front first 8-10 hours late when there's minimal lot traffic)

2. The asshole who does this in a full-size pickup truck and leaves three feet between the back of his car and the wall so that 1/3 of the lane is blocked.

3. The asshole from 1 + 2 above who does this in lots with diagonal parking spots. This drives me insane.

I think this is the proper

I think this is the proper tone. If the GSI presented this as a personal affront, my internal reaction would be, "kiss my ass." If it was presented as "you guys, this is ridiculous. Maybe think about how you want to spend your time" I'd have no problem with it. I do subscribe to the theory that you paid for this opportunity and you have the right to pay attention or not. In a similar vein, I think required attendance in college is ridiculous (exempting classes that are primarily seminar/interaction based). Whether daddy paid for it or if one paid his own way is irrelevant to the argument.

As a former GSI (albeit in the pre-smart phone days) without any particular talent for teaching, I couldn't really blame students for checking out sometimes.  Some people are better book learners, some people struggle with attention span, and sometimes the material that is required to be discussed is god-awful boring.  I remember doing a lecture on amino acid structure which at some point comes down to "you just have to memorize this shit somehow" and there is no way that I know of to convey that in a stimulating lecture.  

As for it being detrimental to other students, I think that argument is largely hollow. Specific examples may not be: the pornography in class crosses a line in my mind.  Overall though, this feels like an argument made by people eager to be offended. If it is that distracting, go sit in the front row...no one else will be there.

Colonoscopy alternative

Just FYI: there is such a thing called "virtual colonography" which is an alternative to colonoscopy.  It can be an option for those with "failed" colonoscopy (couldn't make that hard right turn or get through a stricture) or refuse to get one.  It's a CT scan tailored to your colon.

Cynics may suggest that GI docs don't often recommend them because they don't tend to make money off of them. Radiologist literature says they work pretty good though. Downsides: 1) if they find anything, they can't do anything (biopsy, polypectomy) like they can with a scope, 2) the prep is basically the same (and just about everybody says that's by far the worst part, 3) we still stick a tube in your butt (but it's skinnier and doesn't go as far in...its used to inflate the colon with air), 4) insurance coverage may be tricky.

Personally, I think old-fashioned colonoscopy is the way to go...but something is better than nothing.

So Swenson came up while I

So Swenson came up while I was typing.  Would it really have been "really good" for him to be locked into a program that no longer wanted him?  From the perspective of a Michigan Degree, sure.  But I think the vast majority of kids getting offered by the Michigans of the football world have football goals beyond college and would take a chance to see the football field with Iowa over riding the pine in Ann Arbor, degrees notwithstanding. 

Interesting argument

I could be swayed either way here...I think there are arguments on both sides.  My reservations (other than the no-out-clause issue) mostly center around the presumed benefit of locking these recruits and programs to each other.  

I'm forgetting his name currently but let's imagine the OL recruit from Illinois who we apparently soured on (Swenson) signed an early LOI.  A year later, correctly or not, our staff decides that he has not developed into a player that they think will contribute to the program. As much as many of us didn't really enjoy the "bad look" of us cutting the kid loose, it does seem like that would be preferable to the no-win situation of both the recruit and the school locked in to each other.  He'd have to sit out a year or come into a program that doesn't value him and would have little chance to see the field.  

At that point the school has lost a scholarship spot and the kid has lost his chance to see the field and it sucks for everybody. I think the rule would cut down on over-signing, but there'd be some not-insignificant "baby with the bathwater" effect with recruits/schools getting mutually screwed when life happens and things just don't work out with an otherwise "legitimate" offer.  

I suppose the easy response is "well, don't offer the kid if you're not sure," which...OK.

I love that he said it twice,

I love that he said it twice, without humor and in earnest: "play, coach, and die." I'm sorta flummoxed by all the attention to the uniform silliness and then a gem like that flies under the radar. It's not quite "the team" x3, but it's pretty fucking great.

I tend to agree with those

I tend to agree with those that are cynical of the NBA's motives here, but it is interesting that whatever profit-maximizing calculation they've made landed on the side of the LGBTQ (or whatever the current abbreviation is) community and its allies.

If you, as most that have posted thus far, are against the law in North Carolina, then, regardless of the NBA's motivation, this should be encouraging. People tend to vote with their dollars.

This is very tangentially related to the relative viability of professional women's sports among the big four. I think it's safe to say, as laughable as the WNBA is to many, that basketball has the greatest cross-sex (gender?) appeal. I may be making a false equivalency here, but I'd guess that people who support women's athletics in traditionally male-dominated sports also tend to be against NC's law.

I'm rambling, but I find this stuff interesting. After basketball, it's seems to a big drop off in terms of the popularity of women's sports (among "the big four"). I think "football" is a clear loser. Softball is more popular than hockey, but is it really baseball? I'd put hockey second but I love hockey, live close to Canada, was somewhat disturbingly aroused by the recent gold-medal-winning ladies smoking cigars and drinking cans of beer on the ice and in full uniform.

Feel free to ignore me.

Don't know....but I think

Don't know....but I think it's safe to say Detroit has the worst pedestrians in the country when adjusted for density. I spent four years weaving around people just randomly walking in the middle of Woodward on my daily commute from Ferndale.

Side note: I was lucky enough to spend a few weeks with a friend's family in Beirut and the driving there is f*cking nuts. Bombed out street lights that never got fixed result in an insane game of chicken at every intersection. I saw a 12 year old kid on a moped going the wrong direction on a freeway (in a lane...not on the shoulder) with one arm extended behind him manually towing another kid on a broken down moped.

Side side note: cyclists in Amsterdam! Saw a woman riding her bike through throngs of people/cars/bikes downtown one handed while serenely breastfeeding an infant with her other hand.

New Zealand Hiking

I did a couple of weeks in NZ on the South Island a couple years ago.  Went by myself but joined a group via the guide company "Active Adventures."  Did a 3-4 day/night hike up in the mountains to Lake Angelus, sea kayaked in a few places (including Milford Sound), skydiving and bungee jumping in Queenstown, some very light mountain biking, and a few day hikes.  

The tour company was expensive as hell but a good mix of actually getting out there and doing stuff without having to plan too much or be extremely proficient at outdoorsy-stuff.  Mostly middle-aged couples in my group, but a few younger single people and one awesome early 70's hippy couple.  Some of the middle-aged women were NOT outdoorsy/athletic and managed OK.  Pretty cool company if that's the kind of thing you're looking for.

My AT Hike

Back in 2010, I had 5 months off between finishing school and starting my career and planned to thru-hike the AT. Made it about 300 miles in the dead of winter before my buddy got frostbite and I wimped out on going ahead alone.  Saw literally 4 other people on trail in those 6 weeks.  Had an absolute blast though and it's still one of the coolest things I've ever done.  I kept a journal at the time which I thought/think was/is a pretty good read. Might be of interest to anyone who wants to kill an hour (especially relevant to those who might think of going in the winter (spoiler alert: mountains are cold in the winter...even in Georgia/North Carolina/Tennessee).  I'd be happy to answer any specific questions about my experience if anybody's interested.

Journal link: http://the-at-bjournal.tumblr.com/

(you have to click through to the last page to start at the beginning...it posts in reverse chronological order)

(the second half of the journal is what I did after I got off trail...not really relevant to the OP)

(for anybody serious about trying/planning a thru-hike, whiteblaze.net is an invaluable resource) 

Thanks

Thanks.  I might bug you for that info later.  For now, I found a list on reddit of guys willing to help out with the necessary equipment.  There's a local guy so I'll see where that goes...

Don't think so but...

I'm not really a car guy.  I love driving my new zippy stickshift but couldn't really explain the first thing about how it works.  I think the audio guys would be less likely to have the right equipment as its not just for the radio but pretty much diagnostics/settings for the whole car (and if they did, they'd probably charge just as much). 

I have a sense that there's a pretty decent group of VW/GTI enthusiasts out there and I thought maybe I'd be lucky enough to find one on here with his/her own VCDS thing-a-ma-bob. 

Here's a quick blurb from the wiki page which I think addresses the question of "share-ability:"

VCDS will perform most of the functions of the expensive electronic diagnostic tools available only to official dealers, like the current VAS 505x series diagnostic tools.[4][6] In the past, these dealership-only tools have prevented owners, and many small independent repair shops from performing some fundamental tasks, such as diagnosing problems, diesel ignition timing, modification of convenience options such as automatic door unlocking, coding a replacement electronic control unit (ECU) or key to the vehicle, and monitoring of many vehicle sensors for diagnosing problems.[6] Unlike generic on-board diagnostics (OBD-II or EOBD), VCDS uses the more in-depth Volkswagen Group-specific manufacturer protocol commands,[5] which allows the user to access all diagnostic capable vehicle systems — even in vehicles which are not covered by generic OBD-II/EOBD (e.g. pre-1996). In general, there are two ways to use this software, either as a package (software and hardware) distributed by the manufacturer or their agents, or, by building your own interface hardware and using it with the publicly available but limited shareware version of the software.

Blowout

2004 Buick Rendezvous circa 2006. On the way from A2 to Rochester for rehearsal dinner with fiance and two bridesmaids dressed to the nines.  Total blowout of one of the tires.  Ended up changing the damn thing in rush hour, in my best suit, on the side of 696, with histrionics from the bride-to-be the whole time. 

Not a good omen for the relationship.  In retrospect, I probably wouldv'e been better off if I had lost control of the vehicle and crashed into a fiery Bolivia.

Thread jack (sorry!)Just

Thread jack (sorry!)

Just bought an '09 VW GTI and fiddled with the stereo a bit. Apparently I need some cable/software interface to "flash" the radio setting called VAGCOM/VCDS. My understanding is it takes 3 minutes but the dealership charges $150.

Any MGoBrethren in SE MI have the VCDS hookup and 15 spare minutes to help a guy out?

Hey...I was the manager of

Hey...I was the manager of that concession stand from 1997-98. When were you there?

I think Simmons' new website,

I think Simmons' new website, "theringer.com," is going to continue the "Ask the Maester" column. There was an edition of it included in the first newsletter released by the site.

I'm sorry, but I laugh every time I see PSU's kickoff guy.

I'm sorry, but I laugh every time I see PSU's kickoff guy.

God I love Harbaugh.

God I love Harbaugh.

What the fucking fuck?

What the fucking fuck?

What the fucking fuck?

What the fucking fuck?

Guilty.

Yup...that would be me.  It's probably not even fair to call it a fight: it was more of a scuffle.

Seaholm Class of 2000 shout

Seaholm Class of 2000 shout out to Demorest. We actually got in a fight in middle school which lasted about twenty seconds. I think I started it and Matt ended it (I weighed 70 pounds and Matt was a bit stockier.) He's probably a decent guy 'cause instead of beating the crap out of me he just held me down until I calmed down. Anyway, good luck to him.

Hopefully I've got the right guy...otherwise I'm gonna look sorta insane.

Casey's is still the best.

Still fantastic. I'm more of a lurker around here but had to sign in and represent for the good folks and burgers over at 5th and Depot.  Long live Casey's.

The guy's name is Jon Waters...

...and no one foresaw a "sexualized environment?"

http://en.wikipedia.org/wiki/File:John_Waters_2014_(cropped).jpg

Tennessee

I don't know basketball that well.

Can someone tell my how/why Tennessee is above Duke in KENPOM? And how/why they're an 11 seed? Assuming they beat Mercer, can I watch UM's next game expecting a relatively easy win?

If we lose this game, I'll never visit this website again...so you can save your time with the angry jinx posts.

Zona loss relevant?

I make no claim to be a basketball guru, so forgive me if this is a stupid question: does Arizona's loss today affect our chances at a 1 seed or are they far enough ahead of us that it is irrelevant?

Thanks.

Twin Peaks

There was recently an interview on avclub.com with Sherilyn Fenn (actress who played Audrey Horne).  Billy Zane and Heather Graham's roles (which totally sucked the life out of season 2) were created because Lara Flynn Boyle was dating Kyle Machlachlan and was jealous of  the relationship of "Cooper and Audrey."  There's always been a lot of whispers of behind the scenes issues during season 2, not the least of which was getting cancelled.

Incidentally, I named my dog Special Agent Dale Cooper.  And Audrey Horne was smoking.

 

http://www.avclub.com/article/sherilyn-fenn-talks-david-lynch-and-how-t…

Quarton Alumnus here.

Quarton in 1989! 2nd grade, broken tibia, on crutches.  Resorted to reading books during recess. 

(No subject)

Broke

Heiko,



Do you think you could ask Hoke if he saw ESPN's 30-for-30 documentary, "Broke?" And, what, if anything, does Hoke do to prepare his NFL-caliber players for the challenges of sudden wealth?

My guess would be that he's a

My guess would be that he's a 17/18 year old kid who has the opportunity to travel around the country, gets to hear a bunch of famous adults telling him how awesome he is and how much they like him, and gets to hang out with the most popular guys at major colleges.  

If I was in between my junior and senior year of high school, I would absolutely go check out the college girls for a summer. Especially when you consider some of the more...ummm...adult recruiting tactics that allegedly occur in SEC country.  I say more power to him:  enjoy the ride over the summer, get back to football in the fall, and commit then.