I am a retired ER physician and father of many. After graduating from Chicago Medical School in 1990, I embarked on a 23-year career in Emergency Medicine. Medical interests include wilderness medicine, addictionology, and trauma psychology. I currently teach health and medicine online. DISCLAIMER: Accept all medical advice with a jaundiced eye. Before following my suggestions, do your own research and consult with your physician first. Enjoy & Learn!
My Quora Answer to:
Why does the inside of my left nostril smell?
"There are two major possibilities here, although there may be other less common ones. The first, and probably the most likely explanation, is that the first two antibiotics didn't work."
http://bit.ly/3lIFyrl
My Quora Answer to "Why do people behind you honk at you when you are turning left and waiting for a car to go by in the opposite lane?"
Because some people are addicted to anger. Vehicles become weapons for some, and road rage is a mental illness. Based on my own experiences, I found an inner calm about all aspects of my life, not just driving, when I deliberately decided not to engage in road rage at all. Someone cut you off? Perhaps they are trying to get to the hospital to see a loved one. Someone changed lanes while you were trying to pass? Maybe she was dealing with her child's temper tantrum and didn't see you.
The only thing I do not tolerate is tailgating since that person is not only putting you at risk but also themselves and any passengers. It is the only time I will engage in the passive-aggressive “road rage behavior” of slowing down.
Interesting Psych Findings From Quora. I find numbers 2, 3, 4, 6, 13, and 15 the most interesting.
#22 and #23 are news to me. As is #15. I find it hard to believe it's that long!
You have two Questions and I'll answer them separately.
You are at an age where your hormones are raging so there is the possibility that they WILL get bigger. No guarantees but it's worth a try.
And how do you try? I recommend you get a mass builder shake powder. Take one serving in the morning and once more at bedtime. Add some good oils like coconut oil or it's main fat, MCT oil. How much? Start low like a teaspoon in each shake and increase weekly. Otherwise you might develop Hershey squirts. Olive oil is a good fat, too. For supplements, take fish oil and Vitamins A and D3 which are oils, too. D3 is a precursor to hormones so you get a double whammy
Start lifting weights. That may sound counter-intuitive as a way to gain fat but if your primary goal is an increase in bust size, lifting weights (especially bench presses) will build up your pectoralis muscles, giving you a fuller appearance.
Now, how much gain you will see. I just can't predict because so many variables factor in. Your diet, hormone levels, age, and so on. There's only one way to find out. Just do it.
I'm sorry that others find it difficult to accept you as you are. You didn't choose this so teasing is just a form of bullying. So keep your head up, do what needs to be done, work at it consistently, and experiment.
You can do it!
Early and constant exposure to bacteria common in nature but not so much in cities builds our immune systems in many ways. Think about it. Who gets more exposure to allegens such as pollen and fungi?
I wrote about this a few years ago on my blog titled, “Eat Dirt.” That article was specifically aimed at a genus of bacteria called “Nitrosomas,” but could very well apply to other genera and fungi. Nitrisomas species live off of the form of nitrogen found in urine, urea. Believe it or not, they can live on your skin too, like under armpits. Nature's original deodarant.
Other ingested and inhaled allergens directly affect your internal immune system. For one, chronic low-level exposure stimutes the formation of Immunoglobulins G and M which “overpower” the release and activity of IgE. The IgE molecule (if unopposed) attaches to mast cells in your blood, causing the release of histamine, which is the chemical responsible for all those nasty and even deadly allergic reactions.
According to this 2013 study, rural bacteria also affect natural killer T-cells in the lungs of mice. I haven't read the science behind the article but assume it's valid:
https://www.livescience.com/36217-early-bacterial-exposure-immunity.html
Very good question, BTW.
My Quora Answer to:
Considering the possible link between gut microbiome and depression, what might be the future in treating depression? What steps can be taken now?
Right now, start ingesting a fermented food or drink every day. Consider yogurt, kombucha, real fermented sauerkraut, kimchi, and a little bit of miso or tofu. That is one of my prime Rules for Healthy Living.
In addition, I recommend a twice daily dose of probiotic capsules. Not tablets since they tend to dissolve before entering your intestines. They often contain fillers which can cause a leaky gut. Make sure the capsules don't contain harmful ingredients, also.
I now take a probiotic called Lactobacillus Reuteri. Strains of this bacterium have been found in the guts of many HEALTHY animals, including humans, cows, pigs, sheep, turkeys, and chickens. It is absent in animals that are not healthy. Fowl raised in factory farms live in over-crowded, filthy environments which lead to illnesses, stress, and even depression, an illness called “Poult Growth Depression” (PGD).
I am a physician not a pharmacist, so the next part of my answer is based on my research, not any experience developing drugs. What I do know is that the pharmaceutical industry makes a lot more money from patented products than from naturally occurring medications and supplements. A company did this with fish oil by changing the side chains of the two essential oils in a process called “Omega-3 acid ethyl esterflocation.” These companies do a lot of research which we don't appreciate. One other possibility is to isolate the chemicals produced by L.Reuteri which have psychoactive properties and sell these instead of a live bacterium.
This is a great question and I'm personally excited to see where this leads. Thanks.
Thank you so much, Dr Mangold. I really appreciate the informative, detailed answer. I too am excited about where all of this will lead. In the meantime, I plan to put your suggestions into practice.
You are very welcome. Thanks for that. Sometimes I put in a labor of love in my answers and get zero feedback, so it motivates me again when I get comments like yours.
My Quora Answer to:
What's been your most valuable contribution to humanity?
In order:
1. Seven beautiful, caring, loving, and compassionate children.
2. Being a physician. Especially the ER part.
3. Saving lives.
3. Medical missions to Mexico and Nicaragua.
4. The Medicine Cabinet, my baby. This was a non-profit group I started in the Spring of 1994 in response to the Rwandan civil war. In fact, our shipment of medications and medical equipment was one of the first from the U.S. In 2007, the thugs at the IRS killed my baby, claiming it was just a shell corporation. Despite the fact that I never made a penny from it not accepted cash donations.
5. My “War on Abortions After the First Trimester.”
6. My fight against aborting babies just because they have Down Syndrome. I call this "Geneticide," or the mass extermination of people based solely on genetics.
7. How to Think Like a Doctor and its Spanish translation, Cómo Pensar Como un Doctor.
8. Barefoot Doctors.
9. And my book My Worst Thanksgiving Ever, although you'd be hard pressed to find my “contributions to humanity” but they are there, especially in follow-up.
My Quora Answer to:
Can a man with a weak heart die from an organism?
Orgasm?
If you mean orgasm then the answer is “yes.” The best celebrity anecdote is from Richard Pryor whose own father “came and went” at the same time while having sex with one of his own prostitutes (he was a pimp).
These days, we older men with heart disease need to be extra careful because taking nitroglycerin, having Coronary Artery Disease, and using Viagra to flog a dying horse, all add up to what our special needs government calls a “Black Box Warning.” In other words, proceed with caution. But in all honesty, no one ever in the midst of passion has stepped back to say, “hey, let's think about this first.”
Sildenafil, the generic name/form of Viagra, works by relaxing the smooth muscles that line the arterial (oxygen-carrying) side of our blood system. In penises, that's a good thing. But in horny old men, that means a lot of the blood moves from the core (heart, lungs, etc.) to the periphery, leaving less blood to oxygenate these vital organs. So, at the moment of ecstasy there is a battle, and the poor ol' geezer often loses.
Taps are now on order.
My Quora Answer to:
As a doctor, have you ever been in danger from your patient?
Yes. Just one.
I was working in the ER at Waupun Hospital when the EMT's brought in a patient from a local prison. Waupun, Wisconsin is home to three prisons and close to a few others. The local economy thrives off of kidnapping and caging people.
Before I entered the bay, my nurse pulled me aside and warned me not to get close to the patient. He explained that the prisoner had permanently disabled a nurse at another hospital by attacking her physically during her intake exam. It was the only time in my career when I saw and treated a patient without doing a physical exam.
NB: I always did physical exams even with my psych patients. In addition, a physician can learn a lot just by observation. In medspeech, we document this with “A, A, Ox3, in NAD” which is shorthand for Awake, Alert, Oriented to person, place, and time, and in No Acute Distress. With ambulatory patients we also observe gait and lower body strength but the prisoner was shackled to a gurney and I was NOT going to unchain him just to observe his gait. That's how scared I was.
Answer to Why do doctors often have poor bedside manners, and what as a patient could I do to make their say better?
Because physicians are humans.
You will find the arrogant, rude, inconsiderate, and uncompassionate among us just as in society at large.
However, you will also find the sensitive, caring, loving, and compassionate among us, too. Just like society at large.
I'm not sure about others, but we learned about good bedside manners in med school. My teachers were professors in the Psychiatry Department at the then North Chicago VA. The training was excellent, and I internalized a lot of it. Among other components, we learned which words and phrases not to say, what body language puts patients at ease, and even to change the rate of speech under different conditions. Good stuff.
As for your second question, what can YOU do? Plenty, starting with just letting your doc know how you feel. Try not to make it confrontational. Just simple and honest. This may change how they interact with you, but I doubt you'll make much of a change in their character.
If that doesn't work, write a letter and mail it to the clinic manager/hospital CEO. Snail mail makes a bigger impact than email. That should make some difference. Especially if many others complain.
Then there's always Yelp, or Google Reviews, and so on. Permit me to give you a personal anecdote. I had to change family docs at the end of last year because my insurance changed. My first visit with my new one was February 2nd of this year. The encounter was humiliating.
Last Fall I fell into a manic episode that lasted 6 weeks. During that time I apparently drank. Which is not what I normally do. At one point I fell and kissed the concrete. I was taken by ambulance to an ER where, of course they obtained a blood alcohol level which was just above the legal intoxication level.
Anyway, the new doc walks into the room, introduces himself, then says, “so you are an alcoholic.” Then proceeds to grill me about drinking and abusing drugs, which I have never done. No physical exam, no history taking, nada. On the way out, he says, “see you in 6 months.”
I posted a negative review on Yelp. Someone in the hospital system must have read it and talked to him because at my follow-up visit August 2nd (just last Friday), he was as nice and attentive as can be!
If none of this helps, change docs. It's your right. Good luck.
http://bit.ly/2ML3mXI
Quora Answer to
Have you ever had a patient refuse to believe the diagnosis you gave them?
Yes. But it was through his wife, a Registered Nurse who should have known better.
I was working in an Immediate Care and Occupational Medicine clinic in Burlington, Wisconsin one night during an influenza outbreak. A very sick man came in with typical influenza symptoms: fever, chills, body aches, non-productive cough, sore throat, and nasal congestion/clear nasal discharge. On presentation, he was a well-nourished, poorly hydrated, middle aged White male, ill-appearing, in mild distress. Eyes were white, sclera non-injected, extraocular muscles intact. Pupils equally round and reactive to light and accommodation.
Neck was supple with a full range of motion. He had tender bilateral submandibular lymph nodes (no anterior cervical lymphadenopathy which is important). Nasal mucous membranes were injected (red) and hyperemic (congested) bilaterally with a clear discharge. Oral mucous membranes were dry, his pharynx was injected, but without exudate (pus).
He had a cough and auscultation of his lungs revealed bilateral wheezing but no rales, crackles, or rhonchi. There was good air movement despite the wheezes.
Vital Signs: Heart rate regular at 98 beats per minute; temperature 100.5 degrees F; respiratory rate 15/minute; and oxygen saturation 96%.
The rest of the exam was unremarkable.
Based on my findings and the fact that there was a statewide outbreak, I felt he had influenza, a viral illness. He was also dehydrated so we started an IV to give him fluids. I added dexamethasone (a corticosteroid) for two reasons: to decrease or eliminate the wheezing, and help alleviate his body aches. I added IV Toradol for the same reason. It also brought down his temperature, which really wasn't alarmingly high.
He responded well to treatment. While we were rehydrating him, his wife tracked me down and wanted to know why I didn't order a strep test and chest x-ray. I explained again why I thought he had a viral infection. She wouldn't buy it and demanded I order them. Both are relatively cheap so I did, mainly to placate her. Both came back negative: no strep pharyngitis; no pneumonia.
She wouldn't buy that either, explaining to me that the rapid strep assay was “only 90% accurate.” More precisely, I explained that it is both highly specific and sensitive, with a predictive value (at that time) of almost 95%. Besides, there is also a clinical algorithm that has a negative predictive value of almost 85%. Basically, in the presence of a cough, the abscence of tonsillar exudate, and no anterior cervical lymph nodes, it is highly likely NOT strep. I explained that to his wife, too. Then I asked her what she thought he had. No kidding, this was her answer: “acute sinusitis, strep throat, and pneumonia.” So of course he needed antibiotics. In fact, she demanded them.
First of all, treating a viral infection with antibiotics is poor medicine. Secondly, and if you've read some of my previous Answers you should understand, what she thought were the causes of his illness violates Occam's Razor. As it pertains to medicine, it means that the preferred diagnosis is the ONE that most precisely explains most if not all, of the signs, symptoms, and test results.
Despite accomadating her about the RSA and chest x-ray, I refused to treat him with antibiotics. Soooo… she called the clinic administrator and complained. The administrator drove all the way from Janesville, WI to Burlington to “please, please give him an antibiotic.” I explained to her why I felt that was not medically necessary. She then went to the other doc working that night and he was more than happy to prescribe one. For a patient he didn't even see.
Later, I asked him why and he said that he always prescribed an antibiotic for every patient who presents with a sore throat. Why? His reasoning was that he would rather prescribe incorrectly than miss a strep pharyngitis. I call that “CYA Medicine.”
Remember that clinic because it's central to another much more tragic story of mine.
https://www.quora.com/Have-you-ever-had-a-patient-refuse-to-believe-the-diagnosis-you-gave-them/answer/Michael-Mangold-4?ch=99&share=1154ff98&srid=TCJzj
Answer to Why won't my fever go away even after taking medication from the doctor? by Michael Mangold
The primary answer is that the antibiotic isn't working. It may be due to several reasons including local drug resistance and wrong coverage for that specific bacterium. If the fever hasn't abated after 3–4 days of therapy, go back to your doctor.
Other reasons include that you have a viral infection instead, and lastly that your doc doesn't know what's really going on. I would call that “ignorance” or 'lack of experience” before labeling them a “quack.”
Answers to What can a person do to get fit that has had several knee surgeries, fibromyalgia, and chronic pain? by Michael Mangold
http://bit.ly/2LlE9TX
After delivery and while she was still sedated (it was a C-section), and while I was in the nursery with my new pride and joy, a nurse or other staff person convinced my wife to sign the consent forms. And they KNEW of our stance beforehand! They mutilated our baby against our wishes. And the insurance company paid them for it!