isurg

tbh I'm more interested in what causes alloism

I have one. GFY.

Keto is able to help by filling your diet with things that keep you feeling full (protein and fat) and giving you some straightforward rules that keep you eating those things, which makes you not hungry as often and forces you to have some discipline around eating. I would also add that keto also removes glucose spikes->insulin spikes->glucose dips, removes lots of the low energy hangry loops that most people are stuck in. You can still get cravings and noise on a keto diet though if your nutrition is off. Sure, that would just be biologically appropriate hunger, since the nutrition is off and the body wants more nutrition. I’ve actually done keto before, the strict rules were helpful discipline-wise, but I was able to get all of the same benefits without actually being in ketosis Fantastic! By trying to keep myself eating foods that keep me full, by avoiding binging and keeping my habits in check, and by getting rid of refined carbs (pasta and sugar are the worst, it’s like you didn’t even eat anything) I’ve been able to keep my diet in check pretty well. Did keto not keep you feeling full? Also be careful about saturated fats long-term. It can be bad for your heart if they make up too much of your diet. Thanks for bringing that up. My reading of the literature has satisfied me that in the absence of elevated glucose and metabolic disease saturated fats are actually quite healthy and not a long term health risk (at least for myself).

Gastro-Oesophageal Reflux Disease Doctor Instruction: You are a Foundation Year 1 Doctor working in the Emergency Department. Your next patient is a 42-year-old woman (Anne) presenting with abdominal pain. Please take a history and perform an appropriate examination. Patient History: Anne, a 42-year-old retired hairdresser. This morning at around 3am, you woke up from having tummy pain. Described as a sharp/burning sensation that started at the bottom chest centrally and radiated up to the neck. It is intermittent and lasts for a few seconds. Pain score: 5/10. You are known to have angina, and so you took a GTN spray, but it didn't help. You feel a bit nauseous but no vomiting; you had some retching (and a bad taste in the back of the throat). Pain tends to be worsened or triggered when you try to go back to bed and lay flat. If asked specifically, you remember having quite a big family meal when your friend came to visit the night before. No weight loss. No tiredness. No erosion in teeth. No bad-smelling mouth. No lump in the throat. No bloating. No nocturnal cough. No hoarse voice. Bowels working normally with no bloody stool. No breathing difficulty. No dysphagia. No LOC. No dizziness. No palpitation. No obvious chest pain. Ideas, Concerns, Expectations: You are not sure what is going on. You are worried that you had a heart attack and may die because of this since it is quite close to the chest. You want to be seen by a cardiologist and have some medications to help prevent having this pain again. You want to live! Past Medical History: Hypertension Stable angina - well-controlled Obesity Chronic Lower Back Pain Drug History: Amlodipine, GTN spray PRN, Atovastatin, ibuprofen NKDA Family History: Type 2 DM (Dad, age 44) Colon Cancer (Dad, age 65) Social History: Smoker – 10 cigarettes/day for 20 + years Drink a small glass of gin and tonic every night Hairdresser Drink 2 cups of coffee a day. Examination Findings: The patient is alert + comfortable at rest, with no signs of breathing difficulties. No clinical signs of anaemia. Some mild discomfort palpating the epigastric region. Abdominal examination is otherwise normal. PR exam is normal - no melena or blood in the stool. Differentials: GORD Gastritis Peptic ulcer Hiatus Hernia Oesophagitis / Oesophageal spasm To rule out cardiovascular causes: Stable Angina / ACS / AAA Investigations: Bedside: Observations ECG – rule out cardiac cause Bloods: FBC, CRP, U&Es, LFTs, Bone Profile, Troponin (if suspecting cardiac cause) Imaging: CXR/AXR (?Hiatus hernia) Special Tests: Consider serology/ urea breath test/ stool antigen, rapid urease test (H-pylori testing - ensure not taken PPI 2 weeks prior to testing) Barium swallow - assess dynamics, assess motility disorder, assess for hiatus hernia Oesophageal pH monitoring / Manometry - Assess for motility & regurgitative Disorders Consider OGD (Savary-Miller grading/ Los Angeles Classification) - allows direct visualisation and biopsy for histology. Data Interpretation: Patient Details: Alexander Great Age: 42 Date of Request: 18/04/2023 ​ Value Reference Range ​ Hb 125 g/L 115 - 165 g/L ​ White Cell Count 7.5 x10^9/L 3.6 - 11.0 x10^9/L ​ Platelets 257 x10^9/L 140 - 400 x10^9/L ​ Haematocrit 0.47 x10^12/L 0.40 - 0.54 x10^12/L ​ MCV 94 fL 80 - 100 fL ​ Neutrophils 3.7 x10^9/L 1 - 7.5 x10^9/L ​ Monocytes 0.7 x10^9/L 0.2 - 0.8 x10^9/L ​ Lymphocytes 3 x10^9/L 1 - 4 x10^9/L ​ Basophils 0.03 x10^9/L 0.02 - 0.1 ​ Eosinophils 0.1 0.1 - 0.4 ​ ​ ​ ​ ​ H. Pylori Stool Antigen Test Negative ​ Interpretation of Blood Results: ree Interpretation of OGD Image: Management (GORD): Conservative: Lifestyle changes: stop smoking, weight loss, reduce alcohol intake, sleep more upright, small + regular meals, avoid eating big meals/ alcohol/ hot drinks before bed, avoid triggering diet e.g. spicy food, citrus, chocolate, caffeine, carbonated drinks, alcohol, manage stress level Review medications that can cause reflux, e.g. NSAID, steroids, bisphosphonates, nitrates, calcium channel blockers, alpha/beta agonists, theophylline, anticholinergics Antacids e.g. Gaviscon PPI e.g. omeprazole H2 antagonist e.g. Ranitidine Patient Education Safety netting for uncontrolled and red flag symptoms e.g. ACS Medical: Eradication therapy if tested positive for H. Pylori (PPI plus 2 antibiotics e.g. amoxicillin and clarithromycin) for 7 days. Surgical: Surgery for reflux e.g. fundoplication, magnetic sphincter augmentation. Viva questions: What are the complications of untreated acid reflux? Esophagitis: Inflammation and pain in the esophagus. Barrett's Esophagus: Increased risk of esophageal cancer. Strictures: Narrowing of the esophagus. Esophageal Ulcers: Painful sores in the esophagus. Respiratory Issues: Coughing, wheezing, and asthma exacerbation. Dental Problems: Tooth enamel erosion and oral health issues. Chronic Cough: Persistent cough unrelated to respiratory problems. Laryngitis/Voice Changes: Hoarseness and vocal cord inflammation. Asthma Aggravation: Worsening of asthma symptoms. Difficulty Swallowing: Dysphagia due to esophageal changes. Esophageal Cancer: Increased cancer risk over time. What are the complications of long-term management with omeprazole? Electrolyte disturbance e.g. magnesium Low bone mineral density - interference in gastric pH which can alter calcium absorption What is Barrett's Oesophagus? Barrett's esophagus develops due to chronic acid reflux (GERD). Acid irritates the esophagus, prompting the lining to transform into a type more resistant to acid, called columnar cells. This change is known as metaplasia, resulting in Barrett's epithelium. This condition increases the risk of esophageal cancer, making regular monitoring crucial. What are the red flag symptoms or signs for urgent OGD? Haematemesis or melena Dysphagia Unintentional weight loss Treatment-resistant Early satiety Recurrent vomitting

That will backfire on employers. With the shortage of seniors with good skills, the demand will rise for them. An employer that squeezes his seniors will find them quitting because there will be another desperate employer that will treat them better.

I guess there will be less Americans in the future then...

Well sure, if you're in a time crunch that makes sense. Additionally, you did attempt to shop elsewhere, but in your case it was such a specialized opening you only had one choice from all the retailers available to you. I imagine, had there been multiple to choose from, you would have examined the choices more closely, right?

Brown sugar. It's a "Winter Warmer" style.

My bold claim was saying that Denmark chose the side of Western imperialism and now will have to suffer the expected consequences of it? Are you trying to say your claim isn't a negative thing? In all accepted parsing of the English language, I don't know any other reasonable conclusion from your statement. Since it is negative, you're implying there was a better choice. So what was your implied better choice? And I never said they made a mistake? Oh? Then are you now clarifying that Denmark made the right choice? But what Soviet aggression could they have had if they had been Soviets themselves, for instance? Look at the history of Soviet actions in Poland, Lithunaina, Lativa, and Estonia for your answer. You don't need to answer. I think I've seen enough to lose hope in your posting in good faith.

low blood sugar - hypoglycemia is of concern for people who are not fat adapted, and it speaks problems with insulin function either from t1d or insulin resistance. The best way to avoid low blood sugar, is to avoid eating sugar, so that the body can have a very flat regulation of blood glucose high protein - I've seen no benefit to eating high protein documented anywhere. In fact carnivore is not a high protein diet, its a high fat diet, with adequate protein. The protein targets for a healthy adult do not change based on their diet, they need the same amount of bioavailable protein on SAD, Mediterranean, vegan, keto, or carnivore. As far as any deleterious effects, you would be missing nutrition from fat, but I'm not aware of any actual downsides either. Yes, A first step for everyone should be to eat less processed foods and exercise - totally agreed. I was initially responding to the person above to said keto/carnivore were crackpot pseudo science bs.

You probably don't have diabetes, it takes years and years to build up. Just check on your insulin sensitivity, hba1c, tg/hdl - what have you. Any improvements you can make will improve your sexual functions.

anonymity with XMR is trust. Trust and anonymity don't go together

Thank you! I'm glad you found it interesting!

Fun Fun Fun

Well, I'm very confident the bristles are metal wire.

If you visit the coast, sushi will be a bonus treat.

anac1.html

I am the official spokesman of the UK, never heard of it Oh man, you may need to turn in your Brit Card to the King. The term was likely born in Britain, and used as a central part of the UK's success in WWII. The usage "crib" was adapted from a slang term referring to cheating (e.g., "I cribbed my answer from your test paper"). A "crib" originally was a literal or interlinear translation of a foreign-language text—usually a Latin or Greek text—that students might be assigned to translate from the original language. The term "crib" originated at Bletchley Park, the British World War II decryption operation. source

She's a rotten cunt, scam artist. Don't care how you label it.

Yo, SCOTUS judges can be impeached & removed. And with the upcoming huge Blue Wave... maybe some of the scum will be.