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(New Zealand Herald)   Man blinded by vodka regains eyesight by drinking whiskey   (nzherald.co.nz) divider line 93
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7025 clicks; posted to Main » on 01 Dec 2012 at 11:10 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-12-01 12:30:22 PM

BronyMedic: willfullyobscure: Acupuncture and chiropractic work GREAT for chronic pain and won't land you in the poor house. So get off your high horse, Mr. Middle Class



The evidence for accupuncture is sketchy at best, and the field is massively overrun with woo about energy fields rather than targeting an obvious biological basis for why it works in some people - the release of endorphins, enkephalons, and endocannabanoids.

Nothing a chiropractor does is any different than what a Physical Therapist would do, for cheaper, and using scientific basis for doing so. Chiropractic "medicine" is based on a late 19th century belief that spinal injury and "subluxations" of the vertebra are responsible for all disease in the human body.


acupuncture treats my pain for less than $50/mo, so I don't need pills and you can't tell me any different since its MY pain that goes away. I don't ask them how it works and they don't tell me. my chiro cracks my back and hips so I can walk in the mornings for $40/session. he doesn't give me any crap about diseases either.

you know what the hospital recommend PT was gonna be? 4-500/no with I surance or $1200 out of pocket. and then I dont even get an expert who comes with reviews and outperforms the competition- I get a trainer that flunked out of Planet Fitnesses personal trainer program and thumbed through a kinesiology book at community college for 9 months. I'm supposed to take that over an experienced professional with years of training and experience, and as a bonus, it actually WORKS on me?
 
2012-12-01 12:34:59 PM

BronyMedic: CPT Ethanolic: Gonna have to call bullshiate on this story. Diabetes does not respond differently to liquor. But your mom does.

/boom.

No, the article writer just sucks ass at writing an article.

He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan


You are forgetting about the acidosis angle. Metabolic and/or alcoholic ketoacidosis can cause blindness all by itself -- Nonarteritic Anterior Ischemic Optic Neuropathy or plain AION. They fact that the article mentions diabetes and the doctor smelled "nail polish remover" strongly suggests there was a ketoacidoitic process going on. Acidosis can worsen any methanol poisoning he had by promoting formic acid formation over formate and increase tissue penetration. The ischemic neuropathy can be treated long into the course of the blindness by administering steroids and correcting the acid imbalance. Optic damage from acute methanol poisoning tends to be more permanent over a shorter time period.

In reality, I bet it was a combination of the two. The fact that they didn't use fomepizole and had to go out and buy whisky is weird though.

Just thought of another thing. The interaction he had with this DM-II medication could be Metformin which has a serious ADR of lactic acidosis, I would imagine that could promote the formation of formic acid like any other acidosis.
 
2012-12-01 12:38:56 PM

ga362: Sleeping Monkey

Alcohol: The cause of, and solution to, all life's problems.

Alcohol never solved any problems . . . but neither did a glass of milk!


You might be surprised....
 
2012-12-01 12:41:29 PM

willfullyobscure: you know what the hospital recommend PT was gonna be? 4-500/no with I surance or $1200 out of pocket. and then I dont even get an expert who comes with reviews and outperforms the competition- I get a trainer that flunked out of Planet Fitnesses personal trainer program and thumbed through a kinesiology book at community college for 9 months. I'm supposed to take that over an experienced professional with years of training and experience, and as a bonus, it actually WORKS on me?


A Personal Trainer is NOT a Physical Therapist. They are two completely different professions and educational qualifications.

BigLuca: You are forgetting about the acidosis angle. Metabolic and/or alcoholic ketoacidosis can cause blindness all by itself -- Nonarteritic Anterior Ischemic Optic Neuropathy or plain AION. They fact that the article mentions diabetes and the doctor smelled "nail polish remover" strongly suggests there was a ketoacidoitic process going on. Acidosis can worsen any methanol poisoning he had by promoting formic acid formation over formate and increase tissue penetration. The ischemic neuropathy can be treated long into the course of the blindness by administering steroids and correcting the acid imbalance. Optic damage from acute methanol poisoning tends to be more permanent over a shorter time period.

In reality, I bet it was a combination of the two. The fact that they didn't use fomepizole and had to go out and buy whisky is weird though.

Just thought of another thing. The interaction he had with this DM-II medication could be Metformin which has a serious ADR of lactic acidosis, I would imagine that could promote the formation of formic acid like any other acidosis.


You just gave me my reading topic for today. Thanks Luca!
 
2012-12-01 01:25:38 PM

BigLuca: BronyMedic: CPT Ethanolic: Gonna have to call bullshiate on this story. Diabetes does not respond differently to liquor. But your mom does.

/boom.

No, the article writer just sucks ass at writing an article.

He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan

You are forgetting about the acidosis angle. Metabolic and/or alcoholic ketoacidosis can cause blindness all by itself -- Nonarteritic Anterior Ischemic Optic Neuropathy or plain AION. They fact that the article mentions diabetes and the doctor smelled "nail polish remover" strongly suggests there was a ketoacidoitic process going on. Acidosis can worsen any methanol poisoning he had by promoting formic acid formation over formate and increase tissue penetration. The ischemic neuropathy can be treated long into the course of the blindness by administering steroids and correcting the acid imbalance. Optic damage from acute methanol poisoning tends to be more permanent over a shorter time period.

In reality, I bet it was a combination of the two. The fact that they didn't use fomepizole and had to go out and buy whisky is weird though.

Just thought of another thing. The interaction he had with this DM-II medication could be Metformin which has a serious ADR of lactic acidosis, I would imagine that could promote the formation of formic acid like any other acidosis.


Not doubting you - the smell had to be acetone, I agree - but with formic acid's pKa being 3.7, how would acidosis affect its protonation state at all? You'd have to get below pH 5 to make a real difference in formate/formic acid.
 
2012-12-01 01:27:00 PM

RammaLamma: Well, as a long time home brewer and microbiologist/biochemist, I can tell you that there is no way in the wide world that methanol will ever be present in any commercial brand of alcohol. Also I can tell you that if the alcohol in the vodak reacted with this fellow's meds, so would the alcohol in the whisky.


I have a question for a distiller. Don't most vodka's/everclear type liquors have both the heads and tails of the run in the batch, which have a lot more impurities in them, impurities that might include a trace amount of methanol? And top shelf liquor would have less?
 
2012-12-01 01:28:03 PM
Methanol poisoning? *reads article* Ayup. There was an episode of House MD about this too. He treated the patient by doing shots with the dude.
 
2012-12-01 01:45:03 PM

willfullyobscure: we also call it "affordable treatments for people without insurance". Acupuncture and chiropractic work GREAT for chronic pain and won't land you in the poor house. So get off your high horse, Mr. Middle Class


How about no.


BronyMedic: A Personal Trainer is NOT a Physical Therapist. They are two completely different professions and educational qualifications.


Reminds me of a Dara O'Briain: "Dietitian is like Dentist, and Nutritionist is like Toothiologist."
=Smidge=
 
2012-12-01 01:59:14 PM

ChubbyTiger:

Not doubting you - the smell had to be acetone, I agree - but with formic acid's pKa being 3.7, how would acidosis affect its protonation state at all? You'd have to get below pH 5 to make a real difference in formate/formic acid.


I'm at the limit of my knowledge of the chemistry of this condition, but from what I just read I think I misspoke when I said acidic conditions promote the formation of formic acid. Acidic conditions facilitate penetration of the formic acid into cell thereby enhancing it's toxicity, but you're right, the pHs don't make sense for it to significantly increase the formation of formic acid.

I don't do well with acid/base chemistry though, so all that could be wrong as well. There is also some dynamic with the anion gap, type of anions present in metabolic acidosis, changes in serum buffering, and pH differences in the various body compartments. But most of that is over my head right now, I might have known it at one time, but it was cleared out to make room for fart jokes awhile ago.
 
2012-12-01 02:02:41 PM
Am I the only one seriously amused that this happened to a guy named Denis Duthie?

LIZ: "Where did you come from Denis, I thought you went blind."

DENIS: "Come on Liz, you know I go blind when I drink vodka, but it comes back when I drink whiskey. I'm Irish Dummy"
 
2012-12-01 02:09:18 PM
ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.
 
2012-12-01 02:37:44 PM
whatever happened to vodak?
 
2012-12-01 02:39:17 PM

BigLuca: ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.


No worries. Just curious and I'll try to look it up at work next week. Cheers.
 
2012-12-01 02:40:07 PM

E_Henry_Thripshaws_Disease: whatever happened to vodak?


Most people realize you're retarded if you intentionally misspell it. Props to subby, which I rarely say.
 
2012-12-01 02:42:10 PM

BigLuca: ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.


And... this is why I think requiring med students to take two years of Chemistry is a waste of time, because they're not going to remember it anyway.

The way this works is formate (which is the same thing as "formic acid") and glyoxylate exist as charged species at the normal pH of most people (which is about 7.4). Those charged species have a COO-

If the person who has formate or glyoxylate is also acidemic (their pH is much lower than 7.4), then those charged species get protonated (i.e. COO- picks up a proton, and it become COOH.) This is bad because when the metabolites were negatively charged, they will have a very tough time penetrating end-organ tissues, whereas if they are neutral, then they are much more hydrophobic, and much more able to penetrate end-organ tissues.

Summary: Neutral things are more hydrophobic than charged things and can be absorbed better into end-organ tissues. Acidemia causes protonation of negatively charged acid metabolites, which then become neutral. To treat someone who has both ingested formate (or glyoxylate) AND has acidemia, you should treat with sodium bicarbonate, which will raise the pH, which will deprotonate the acidic species. You should also take the usual steps to treat the methanol or anti-freeze ingestion.
 
2012-12-01 02:53:15 PM

BronyMedic: willfullyobscure: you know what the hospital recommend PT was gonna be? 4-500/no with I surance or $1200 out of pocket. and then I dont even get an expert who comes with reviews and outperforms the competition- I get a trainer that flunked out of Planet Fitnesses personal trainer program and thumbed through a kinesiology book at community college for 9 months. I'm supposed to take that over an experienced professional with years of training and experience, and as a bonus, it actually WORKS on me?

A Personal Trainer is NOT a Physical Therapist. They are two completely different professions and educational qualifications.



my point was the average PT at a rehab clinic is someone that couldn't hack the hard work, dedication and intellectual rigor of becoming a personal trainer so they switched to the physical therapist track their local cow college. Not to mention there's probably less scientifically rigourous evidence to support the bulk of PT exercises than there is for acupuncture. these people are kooks and tards, so I'll stick with my providers, even if they aren't part of your orthodoxy.
 
2012-12-01 02:54:44 PM

BronyMedic: willfullyobscure: you know what the hospital recommend PT was gonna be? 4-500/no with I surance or $1200 out of pocket. and then I dont even get an expert who comes with reviews and outperforms the competition- I get a trainer that flunked out of Planet Fitnesses personal trainer program and thumbed through a kinesiology book at community college for 9 months. I'm supposed to take that over an experienced professional with years of training and experience, and as a bonus, it actually WORKS on me?

A Personal Trainer is NOT a Physical Therapist. They are two completely different professions and educational qualifications.



my point was the average PT at a rehab clinic is someone that couldn't hack the hard work, dedication and intellectual rigor of becoming a personal trainer so they switched to the physical therapist track their local cow college. Not to mention there's probably less scientifically rigourous evidence to support the bulk of PT exercises than there is for acupuncture. these people are kooks and tards, so I'll stick with my providers, even if they aren't part of your orthodoxy.  Nice of you to completely ignore my main point, which that alternative therapies are popular becuase mainstream medicine is not accessible to a very, very large part of the population, moneybags.
 
2012-12-01 02:56:35 PM

Smidge204: willfullyobscure: we also call it "affordable treatments for people without insurance". Acupuncture and chiropractic work GREAT for chronic pain and won't land you in the poor house. So get off your high horse, Mr. Middle Class

How about no.


Are you really suggesting I should not pursue treatment that is safe, affordable and effective based on my own experiences? It WORKS, so get over it.
 
2012-12-01 02:58:03 PM
Mugato:

BronyMedic: He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan

"Look at the big brain on BronyMedic! You a smart motherfarker."


He should know about this stuff, he's frigging medic.

Yeah, we disagree on several things but he's not a total moron.
 
2012-12-01 03:00:56 PM
CreamFilling:

And no one seems to consider the possibility that his students tried to poison him.

I was wondering about that. Is it what the article seems to say -- that his diabetes medication turned ethanol into methanol (?) -- or was something wrong with the vodka? If the latter, was it commercial vodka that had been poisoned or homebrew vodka that was badly made?

Singed,
Confused again In KY
 
2012-12-01 03:03:02 PM
Albert911emt:

Whiskey is better than vodka.

For sipping. For guzzling to get drunk fast vodka's better.
 
2012-12-01 03:06:51 PM
LoneVVolf:

I was fumbling around the bedroom for the light switch but ... I'd just gone completely blind."

He thought he'd sleep it off, but the next morning...

Yes, because when one is suddenly struck completely blind, a logical thought is "Eh, maybe this will fix it self if i wake up in the morning."


I'd be shrieking my fool head off, crawling around for the phone to all 911, stumbling down the hall to bang on neighbors' doors...

This guy's too stoical for his own good.
 
2012-12-01 03:12:31 PM
GoldDude:

Johnny Walker Black? B'ah! Just kill me already rather than feeding me that crap!

[www.lcbo.com image 640x721]

\not too late to change this into a whisky (not whiskey!) snob thread!


McClelland's Islay is a 7 year old Bowmore. Like $25 here in Lexington, KY. Not that I won't drink the older stuff if somebody SENDS ME MONEY (hint hint).

My favorite blended is Black Grouse. So far.

I'm getting tired of bourbon.
 
2012-12-01 03:15:50 PM

Smidge204: willfullyobscure: we also call it "affordable treatments for people without insurance". Acupuncture and chiropractic work GREAT for chronic pain and won't land you in the poor house. So get off your high horse, Mr. Middle Class

How about no.


BronyMedic: A Personal Trainer is NOT a Physical Therapist. They are two completely different professions and educational qualifications.

Reminds me of a Dara O'Briain: "Dietitian is like Dentist, and Nutritionist is like Toothiologist."
=Smidge=


Give me one single, solitary reason that Theraputic Ultrasound, which can be found in a preponderance of "legitimate" rehab clinics, should be covered by insurance and not acupuncture. And then tell me why I should have to either pay more than I can afford, or shun an alternative, effective treatment from a private clinic simply because a dude in a white coat doesn't like it. If you can't, take your smug little orthodox medical establishment views, in which you place at least as much unreasoned faith as the daffiest crystal gazer, and go on home.
 
2012-12-01 03:16:43 PM
BronyMedic:


BigLuca: You are forgetting about the acidosis angle. Metabolic and/or alcoholic ketoacidosis can cause blindness all by itself -- Nonarteritic Anterior Ischemic Optic Neuropathy or plain AION. They fact that the article mentions diabetes and the doctor smelled "nail polish remover" strongly suggests there was a ketoacidoitic process going on. Acidosis can worsen any methanol poisoning he had by promoting formic acid formation over formate and increase tissue penetration. The ischemic neuropathy can be treated long into the course of the blindness by administering steroids and correcting the acid imbalance. Optic damage from acute methanol poisoning tends to be more permanent over a shorter time period.

In reality, I bet it was a combination of the two. The fact that they didn't use fomepizole and had to go out and buy whisky is weird though.

Just thought of another thing. The interaction he had with this DM-II medication could be Metformin which has a serious ADR of lactic acidosis, I would imagine that could promote the formation of formic acid like any other acidosis.

You just gave me my reading topic for today. Thanks Luca!


Hey BM, I'd love it if you translate what you learn into English for dullards like me. I could write a bood on the Christological controversies of the 4th century church, but science, like math, is HARD.
 
2012-12-01 03:24:45 PM

ExcaliburPrime111: BigLuca: ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.

And... this is why I think requiring med students to take two years of Chemistry is a waste of time, because they're not going to remember it anyway.

The way this works is formate (which is the same thing as "formic acid") and glyoxylate exist as charged species at the normal pH of most people (which is about 7.4). Those charged species have a COO-

If the person who has formate or glyoxylate is also acidemic (their pH is much lower than 7.4), then those charged species get protonated (i.e. COO- picks up a proton, and it become COOH.) This is bad because when the metabolites were negatively charged, they will have a very tough time penetrating end-organ tissues, whereas if they are neutral, then they are much more hydrophobic, and much more able to penetrate end-organ tissues.

Summary: Neutral things are more hydrophobic than charged things and can be absorbed better into end-organ tissues. Acidemia causes protonation of negatively charged acid metabolites, which then become neutral. To treat someone who has both ingested formate (or glyoxylate) AND has acidemia, you should treat with sodium bicarbonate, which will raise the pH, which will deprotona ...


Yep, get all that. What we were discussing was the formic acid pKa of 3.7. From what I remember of pKa's, above 3.7 you will have almost totally formate, and it converts almost totally formic acid at 3.7. And this is not a proportional thing, it's pretty sudden (within 1 pH or so). So at pH 7.4 (normal pH) you will have about the same ratio of formic acid to formate as at pH 6.0 (pretty damn acidic). I've never hear of anyone's blood pH being lower than 6.0. Maybe the tiny increase in formic acid you get from a pH of 7.4 to a pH of 6 is physiologically significant? I don't know, I forgot how to figure that out, I just remember it is not much of a change at all.

I swear to god if I have to look up the Henderson-Hasselbalch eqution and find a calculator with a log button, I"m going to be pissed.

And... this is why I think requiring med students to take two years of Chemistry is a waste of time, because they're not going to remember it anyway.

I agree
 
2012-12-01 03:50:35 PM

The One True TheDavid: Hey BM, I'd love it if you translate what you learn into English for dullards like me. I could write a bood on the Christological controversies of the 4th century church, but science, like math, is HARD.


Sorry, I tend to talk technical without realizing it. I'm like that in real life, but much quieter. I have to catch myself.

So, you have this enzyme. It's called Alcohol Dehydrogenase. It breaks down alcohols like methanol and ethanol into simpler chemicals so it can be either used or eliminated from the body, and prevents it from being toxic to your cells.

So, think of Alcohol Dehydrogenase as a horny guy at a bar.

So, let's say the first thing he sees a methanol. We'll make her the fat chick. He's not having any other luck tonight, and he's desperate. So he's going to get with Methanol, and have a little fun at the end of the night. Unfortunately for Alcohol Dehydrogenase, he leaves a mess in the morning. Formaldehyde. So this second enzyme, Aldehyde Dehydrogenase - it acts as the housekeeping in the morning. It picks up the Formaldehyde, and while meaning to do good, turns it into Formic Acid. Formic acid then attacks your retinas and optic nerves, and leads to blindness. It also massively farks with your kidney function.

But, let's reverse the scenario. Say right behind methanol, ethanol walks in. Ethanol is smokin' hot, and has all of Alcohol Dehydrogenase's fetishes. He's going to go with Ethanol over Methanol. Methanol's going home alone. Methanol alone, without being metabolized, is not very toxic - the kidneys pull it out, and it gets excreted in the urine. That's why they used to give these people IV or PO ethanol to maintain their BAC at 0.1 or Above.

Now, we use Fomepizole. It cockblocks Alcohol Dehydrogenase.

BigLuca: Yep, get all that. What we were discussing was the formic acid pKa of 3.7. From what I remember of pKa's, above 3.7 you will have almost totally formate, and it converts almost totally formic acid at 3.7. And this is not a proportional thing, it's pretty sudden (within 1 pH or so). So at pH 7.4 (normal pH) you will have about the same ratio of formic acid to formate as at pH 6.0 (pretty damn acidic). I've never hear of anyone's blood pH being lower than 6.0. Maybe the tiny increase in formic acid you get from a pH of 7.4 to a pH of 6 is physiologically significant? I don't know, I forgot how to figure that out, I just remember it is not much of a change at all.


The lowest PH I've seen in a live patient is 6.7, and that was in a massive new onset Diabetic Ketoacidosis. I've seen 6.2, but that was a blood gas taken inguinal after we had been working the kid for fifty minutes during cardiac arrest.
 
2012-12-01 04:01:29 PM

The One True TheDavid: Mugato:

BronyMedic: He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan

"Look at the big brain on BronyMedic! You a smart motherfarker."

He should know about this stuff, he's frigging medic.

Yeah, we disagree on several things but he's not a total moron.


Dude, I was just quoting Pulp Fiction. I'm sure everything he said was accurate.
 
2012-12-01 04:06:28 PM

BronyMedic: willfullyobscure: my point was the average PT at a rehab clinic is someone that couldn't hack the hard work, dedication and intellectual rigor of becoming a personal trainer so they switched to the physical therapist track their local cow college. Not to mention there's probably less scientifically rigourous evidence to support the bulk of PT exercises than there is for acupuncture. these people are kooks and tards, so I'll stick with my providers, even if they aren't part of your orthodoxy.


Poe, troll, or (optimistically) he's just kidding. There might be one person in the world that actually believes that and the chances that he could use a computer are pretty slim.
 
2012-12-01 04:24:21 PM

BigLuca: BronyMedic: willfullyobscure: my point was the average PT at a rehab clinic is someone that couldn't hack the hard work, dedication and intellectual rigor of becoming a personal trainer so they switched to the physical therapist track their local cow college. Not to mention there's probably less scientifically rigourous evidence to support the bulk of PT exercises than there is for acupuncture. these people are kooks and tards, so I'll stick with my providers, even if they aren't part of your orthodoxy.


Poe, troll, or (optimistically) he's just kidding. There might be one person in the world that actually believes that and the chances that he could use a computer are pretty slim.


No, that's true. Like how surgeons are just people who weren't smart enough to be tailors.
 
2012-12-01 04:26:45 PM
CreamFilling:

Like how surgeons are just people who weren't smart enough to be tailors.

No, silly: surgeons cut apart, tailors sew together.
 
2012-12-01 04:39:25 PM

CreamFilling: BigLuca: BronyMedic: willfullyobscure: my point was the average PT at a rehab clinic is someone that couldn't hack the hard work, dedication and intellectual rigor of becoming a personal trainer so they switched to the physical therapist track their local cow college. Not to mention there's probably less scientifically rigourous evidence to support the bulk of PT exercises than there is for acupuncture. these people are kooks and tards, so I'll stick with my providers, even if they aren't part of your orthodoxy.


Poe, troll, or (optimistically) he's just kidding. There might be one person in the world that actually believes that and the chances that he could use a computer are pretty slim.

No, that's true. Like how surgeons are just people who weren't smart enough to be tailors.


Did you know that NASA is entirely made up off failed carnies? True story.
 
2012-12-01 04:41:31 PM

The One True TheDavid: CreamFilling:

Like how surgeons are just people who weren't smart enough to be tailors.

No, silly: surgeons cut apart, tailors sew together.


No, they both do both. But with surgery there's a lot more room for error.
 
2012-12-01 05:04:55 PM

BigLuca: BronyMedic: willfullyobscure: my point was the average PT at a rehab clinic is someone that couldn't hack the hard work, dedication and intellectual rigor of becoming a personal trainer so they switched to the physical therapist track their local cow college. Not to mention there's probably less scientifically rigourous evidence to support the bulk of PT exercises than there is for acupuncture. these people are kooks and tards, so I'll stick with my providers, even if they aren't part of your orthodoxy.


Poe, troll, or (optimistically) he's just kidding. There might be one person in the world that actually believes that and the chances that he could use a computer are pretty slim.


the job pays $11/hr, bro. they aren't signing up the best and brightest. throw in the kinesiology/laser therapy/science fad of the week kookery and I have yet to see a convincing reason to believe there's some natural advantage here vs chiro and acupuncture.
 
2012-12-01 05:07:04 PM

BigLuca: ExcaliburPrime111: BigLuca: ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.

And... this is why I think requiring med students to take two years of Chemistry is a waste of time, because they're not going to remember it anyway.

The way this works is formate (which is the same thing as "formic acid") and glyoxylate exist as charged species at the normal pH of most people (which is about 7.4). Those charged species have a COO-

If the person who has formate or glyoxylate is also acidemic (their pH is much lower than 7.4), then those charged species get protonated (i.e. COO- picks up a proton, and it become COOH.) This is bad because when the metabolites were negatively charged, they will have a very tough time penetrating end-organ tissues, whereas if they are neutral, then they are much more hydrophobic, and much more able to penetrate end-organ tissues.

Summary: Neutral things are more hydrophobic than charged things and can be absorbed better into end-organ tissues. Acidemia causes protonation of negatively charged acid metabolites, which then become neutral. To treat someone who has both ingested formate (or glyoxylate) AND has acidemia, you should treat with sodium bicarbonate, which will raise the pH, w ...


By using the Henderson-Hasslebach equation, you can figure out what ratio of protonated to unprotonated formic acid there is.

pH = pKa + log ([A-]/[HA]), where pH is the person's pH, pKa is the pKa of the chemical, [A-] is the concentration of the deprotonated form, and [HA] is the concentration of the protonated form.

So, for someone with a pH of 7.4 (normal) and formic acid's pKa of 3.7, you would get a ratio of [A-] to [HA] of 5000:1 (i.e. mostly deprotonated form.)

But if you drop the pH to say, 6.8, which is entirely plausible for this patient (it might be even lower) then the ratio changes to about 1250:1. There's still almost all of the formic acid in the deprotonated form, BUT, the concentration of the protonated form is now quadruple what it was. You only need a tiny bit to be absorbed into sensitive end-organs to get severe damage.
 
2012-12-01 05:36:26 PM

ExcaliburPrime111:
By using the Henderson-Hasslebach equation, you can figure out what ratio of protonated to unprotonated formic acid there is.

pH = pKa + log ([A-]/[HA]), where pH is the person's pH, pKa is the pKa of the chemical, [A-] is the concentration of the deprotonated form, and [HA] is the concentration of the protonated form.

So, for someone with a pH of 7.4 (normal) and formic acid's pKa of 3.7, you would get a ratio of [A-] to [HA] of 5000:1 (i.e. mostly deprotonated form.)

But if you drop the pH to say, 6.8, which is entirely plausible for this patient (it might be even lower) then the ratio changes to about 1250:1. There's still almost all of the formic acid in the deprotonated form, BUT, the concentration of the protonated form is now quadruple what it was. You only need a tiny bit to be absorbed into sensitive end-organs to get severe damage


At pH 6.8 the protonated form is .0792% of total.
At pH 7.4 the protonated form is .0199% of total.

If I think of it in a gen chemistry class way, both those numbers are so small there is little real difference. But if i think about it in a physiologic way, one number is quadruple the other and would have a huge impact on cell functioning. So that makes sense I guess.

Thanks for breaking it down for me.
 
2012-12-01 06:01:23 PM

ExcaliburPrime111: The whole "vodka interfered with diabetes medication" is BS in this instance. Although unclear from the article, it appeared as if the guy's students homemade the vodka, or at least purchased something really crappy, which was obviously tainted with methanol.

Competitive inhibition of methanol with ethanol is a well-established medical treatment. I'm surprised that even after he tried "sleeping it off" that the treatment still worked. What he needs to do to avoid this in the future is avoid home distilled or crappy alcohol.


But this was FREE alcohol! How do you compete with free?
 
2012-12-01 06:12:17 PM

willfullyobscure: Smidge204: willfullyobscure: we also call it "affordable treatments for people without insurance". Acupuncture and chiropractic work GREAT for chronic pain and won't land you in the poor house. So get off your high horse, Mr. Middle Class

How about no.


BronyMedic: A Personal Trainer is NOT a Physical Therapist. They are two completely different professions and educational qualifications.

Reminds me of a Dara O'Briain: "Dietitian is like Dentist, and Nutritionist is like Toothiologist."
=Smidge=

Give me one single, solitary reason that Theraputic Ultrasound, which can be found in a preponderance of "legitimate" rehab clinics, should be covered by insurance and not acupuncture. And then tell me why I should have to either pay more than I can afford, or shun an alternative, effective treatment from a private clinic simply because a dude in a white coat doesn't like it. If you can't, take your smug little orthodox medical establishment views, in which you place at least as much unreasoned faith as the daffiest crystal gazer, and go on home.


Physical therapists make a lot more money than chiropractors. Add in the fact that they're typically employees of hospitals rather than self employed practitioners and they get much better benefits. Not that those facts mean they're any more qualified, but your argument based on the opposite is demonsstrably wrong.
 
2012-12-02 08:34:44 AM

willfullyobscure: Are you really suggesting I should not pursue treatment that is safe, affordable and effective based on my own experiences? It WORKS, so get over it.


I'm suggesting that acupuncture is not safe, and that (per the study discussed in the video) it's not even as effective as someone poking you with wooden toothpicks.

I'm not saying it doesn't work versus "no treatment" - I'm saying it's less safe and less effective than other, equally placebo-based treatments.
=Smidge=
 
2012-12-02 03:04:21 PM
bender have u been up all night not drinking?

www.oocities.org
 
2012-12-02 08:30:12 PM
Whisky, is there anything it can't do? Cures livers diseases too!
 
2012-12-02 10:58:09 PM

Smidge204: willfullyobscure: Are you really suggesting I should not pursue treatment that is safe, affordable and effective based on my own experiences? It WORKS, so get over it.

I'm suggesting that acupuncture is not safe, and that (per the study discussed in the video) it's not even as effective as someone poking you with wooden toothpicks.

I'm not saying it doesn't work versus "no treatment" - I'm saying it's less safe and less effective than other, equally placebo-based treatments.
=Smidge=


You still haven't addressed the fact that alternative medicine is popular not becuase of mass delusion, but becuase its far cheaper and more accessible that equally unproven mainstream medical practices. Anyway shows what you know about the topic, there's non-penetrative acupuncture, moxibustion and shiatsu to boot. I'll take my chances with an acupunture expert over some half-baked physical therapy derp. This is my gold standard for evaluting medical treatments for true science. *Most* of medicine is not equal to this standard, East or West. Study it out, you'll see.
 
2012-12-03 05:43:36 AM

willfullyobscure: Study it out, you'll see.


www.smidgeindustriesltd.com

So the double-blind study is your "gold standard" for evaluating medical treatments, but you'll take treatment that has only ever failed clinical testing versus placebo over treatment that has shown effective?

Mmm...
=Smidge=
 
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