jdrose @DellaroseJacque

Made it to Ugly Betty S1:E20 and just couldn't go further. The poor audio quality. Goofy and choppy episode story lines. Trying to watch this with my 5yo daughter like we watched Mr. Monk and The Devil Wears Prada, but just can't. Ugly Betty is a great character though! Even Daniel, with all his promiscuity and city, high-life living is an incredibly kind and likeable character albeit a bit immature at times. In my mind, I thought Ugly Betty was going to evolve into something like Mr. Monk. But now I can't see that character evolve and be the focus, because the show currently seems to be about everything except the main character that we all ❤️

My partner had a breast related biopsy due to some recent concerns. She received the bill later for ~$3900. She applied for financial assistance from the hospital and it was approved. We wanted to pay, but it was either pay-a-sh*tload or totally-free. There was no in between option at all. When approved for the totally-free option, the hospital was also kind enough to to grant her 5 or 6 more months of totally free care that ended today. During that time, she saw other Drs in the same hospital department and they said that the $3900 biopsy was done in the completely wrong place from the scans and the results are now useless and a other one will need to be done. As these 6 months have passed, she has gone to many other visits at the same place to keep trying to address some symptoms. All of those visits and test were covered until today by the hospital financial aid. Yet, I keep getting insurance claim notifications and log into my insurance app and the hospital appears to have been billing the insurance for all these visits but at what appears to be more logical or reasonable rates. The insurance is just approving it with no cost back to us, even with the deductible we have not met this year. I am so confused. She is clearly receiving financial assistance from the hospital network, but are they still getting paid by our insurance through these claims? She is very grateful for the assistance, but would actually just like to pay ourselves at the more reasonable prices that the insurance is now being billed after the financial assistance was approved. I don't understand how the deductible is not currently involved and how it appears that the hospital is getting paid by insurance without us. It's like a dream where insurance is working exactly how insurance should work in a perfect world where we don't think about it or interact with it at all, but the Drs and hospital still get paid fairly. What's ironic now though is that the financial aid ended today and she is no longer elgible for financial assistance and she still needs the retake of the $1800 biopsy that the hospital originally billed us $3900 for when the other Dr completely botched the procedure by working on the wrong side. Guess what else happened? We logged in to the Epic MyChart and found today that the approval letter for financial assistance that she received there in March had been completely deleted from the messages and letters section of the MyChart account. The direct link we had in txt messages to a storage blob also had the letter completely deleted/removed. I had to msg and ask them to send the letter and they still had it even though it was gone from the account completely before we asked. If we didn't catch this she would have had a contrast MRI Sunday and the biopsy retake in a few weeks again. We would've been unexpectedly slammed with $5k+ surprise bills. She did manage to follow directions through numerous long and dark hallways to find a financial aid office where sh has been trying to still get some assistance due to the original, botched biopsy by the first Dr. Again, we want to pay, but want to pay the fair market value of the procedure in our region as set by MDSave/Tendo market for an unbotched biopsy. Even the high side of that is ok, but 2-3x does not seem ok. We are grateful but still don't have the answer we were looking for after all of this time off work for appointments and may still get slammed with surprise bills in the coming months that appear to be 3x the fair market value of the procedure. Will it ever make sense? I bet the folks in the hospital financial aide office have some stories that could rival the Drs just without all the blood and guts.

I am once again coming to you to tell you that living dehydrated feels like shit and basically everyone is doing that. Fitness goals aside, you just feel better. Better mood, better skin, better oral energy levels, better cognitive ability. Everything is much better with consistent water.

Your two month wait to see an orthopedic surgeon is not a doctor shortage. It is a business model. One surgeon proved it by quitting the model entirely. Daniel Paull was partway through a hand surgery fellowship, nine years of training behind him, when he quit, moved to Colorado, and built something that is not supposed to exist: a cash only orthopedic surgery practice with no insurance of any kind. No Medicare, no Medicaid, no Tricare, no commercial plans. Two years in, he does surgeries, keeps an office, and runs about half his visits as house calls. The mechanism is the interesting part. Taking insurance, by his math, means hiring roughly five full time people just to deal with it. It means more office space to hold them. It means an EMR that every doctor hates because it is built for billing, not note taking. That overhead has to be fed, so the practice sees more patients in less time, and the thing he calls the core of medicine, the relationship with the patient, is what gets squeezed to pay for it. So he removed the layer instead of feeding it. What is left is a practice where an appointment at a busy orthopedic office can take a month or two, but a call to him gets you seen the same day or the next. Where the visit is not rushed. Where every patient has his phone number and is encouraged to call and text, and he answers, and if he is running late to the next patient he says so himself. Cash at the end of the visit, low overhead, a staff of two. When a patient is an hour and a half away, he drives, with the cost factored in. He is careful to say the quiet part correctly: doctors inside the system are talented. It is not about the doctor. It is about the business model of delivery. The origin was not a business plan. It was the moment the training treadmill stopped making sense to him: "there's no light at the end of the tunnel, it's just a series of tunnels." Some doctors dabble in cash pay on the side. Fully detached from insurance in orthopedic surgery, he does not think anyone else is doing it, and he says he would like to learn about them if they are. Most of his physician referrals come from direct primary care doctors, because a fifteen or twenty minute in-system visit leaves no room to explain cash pay economics to a patient who has never considered it. In his telling, a patient has to understand cash pay before the model can serve them, and that familiarity is the gating constraint on direct specialty care. Daniel Paull is an orthopedic surgeon, and the full conversation covers how the model works, who it fits, and where it breaks. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. What would your specialty look like with no billing department to feed? #ThePodcastbyKevinMD #DirectCare

I have some work gloves I really like and have bought 8 times from online retailer. The seller has slowly increased the price so they are now 2-3x when I first began buying them. After trying to replace them unsuccessfully with one that look similar, I just gave Google AI mode the technical markings on them from the manufacturer and it gave me two alternatives on the same online vendor that are still 1/3 of the price and meet the exact same international specifications. This will save me $50-$100 a year. More money for momma's lovin. 🇱🇷

Basically closed captioning in my preferred language in a 'screenplay-like' format that Identifies each speaker in text next to each written translation. The AI voice was used for aome of us but then the AI tried to imitate my guest voice in the language it was translating to. It was very strange.

I used the AI live voice translator in one of my multilingual Teams calls this week. It was useful but would be easier to focus if there was a transcription-to-preferred-language only mode. After 3 hours, I'm convinced it's impossible for UN diplomats to get anything done.

Thank You

CoffeeBlackMD @CoffeeBlackMD

a day ago

I work with a mid levels in both the ICU and my pulmonary clinic. And I generally think they are fantastic. I get so much pressure to move my new patients immediately into the mid levels clinic. But I think until diagnosis is established and patient stabilized, they should see

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I think this case also speaks to the power and dangers of psychiatric meds. When I was in high school a 45+ year old man living with his mom filled up their toilet with concrete and the psych meds he had been on. Grabbed a shotgun, drove 10 miles, and started killing and injuring teenagers in the middle of a worship service. I often wonder how much of the sh* like this that happens in the world can be tracked back to having some influence from psych meds f*ing up the brain chemistry of otherwise normal (albeit depressed and maybe a bit odd) folks.

Inside Edition has been covering this as their headliner this week. It's definitely mind boggling in many ways. I mean just the husband already being married to the fertility doc is such a weird thing. And then how it happened where she sends hubby out on todo list like dinner pickup. So much pre-planning. Then to fail the suicide attempt in that way and have to keep living with this after the darkness clears. Ouch.

Prefer light cardio like a few jumping jacks sets first to losen muscles a bit (but not too much if you sweat a lot like me and are in a shared equipment gym). Then I save the heavier cardio later for afternoon or evenings. I prefer weights in mornings and cardio in evenings. Personally I really dislike the idea of 30-50+ minutes of cardio after just completing 45-90 minutes of weight/core exercises and am already feeling wiped out. When I go through periods in life of outdoor cardio only, I will work in pushups/pullups/core exercises sets before and after the cardio but sometimes in the middle during breaks.

The most unhappy that I have ever been in my entire life & career was the 2 years I was caught in between IST born leaders and IST born customers. I wish this wasn't a truth to me, but it absolutely is.

Just overheard my son and friend (~11yo) discuss how all they need to do is tape a strawberry 🍓 to the wall and sell a picture of it to become super rich. His friend had just finished telling him about that multimillion dollar banana 🍌 art that sold in the last year or two. 😂

@DrSuneelDhand Glycinate gives me very vivid nightmares. L-threonate does not. Obv not the same. Thought I was crazy with how vivid they were until I saw some reddit posts with ppl describing the same thing. Also made my bowels feel loose for some reason. To me it wasn't worth it.

Big Square Headed Dogs - a mixed one almost ripped my 5 yo son's eye out of his face when I let my guard down for a minute after 7+ years. Wish I had seen this.

So I agree in theory even though most DR in the USA would probably disagree (especially when put in the context of Ivermectin). I wanted to try a parasite clense so that's why I was working with the AI to see if it made sense for me. I don't spend time around animals or in rural settings very often but here's why I went the direction I went (pursuaded by my AI non-DR medical advisor): -It was clear in the discussion that any parasites I would be targeting would be 1) taxoplasmosis (micro cysts forming parasites) or 2) cysticerosis (tapeworm/tapeworm larvae). -For #1 those are the ones that live in us our whole life locked in their cyst and we can't get them out. Even if we could, we'd do more harm than good potentially trying. -For #2, ivermectin wasn't going to be the preferred method. The AI made it clear that for my lifestyle, region, diet, etc that any anti parasitic cleanse would require pyrimethamine + sufadiazin and/or albendazole or praziquantel for the parasites and parasite lifecycle stages that we would target. Those drugs are only available by perscription and it would not be worth my time and definitely not a DRs time to get this going unless I had a lab test or symptoms suggesting I had a problem. Just getting that preventative lab test (while doable with sites like walkinlab or home test companies Everlywell), would be more trouble than it's worth with Dr supervision and insurance billing. Furthermore, the AI was clear that there are liver and kidney toxicity concerns with any of the anti parasitic drugs we were considering. although the cleanse would be quick, I decided not to further burden these organs alon with the other supplement protocol I am testing. This is why I pivoted. The science indicated that Ivermectin specifically wasn't going to help for my scenario. Now that doesn't mean I'm not doing anything. The Emulsified Oregano oil extract pills do have some anti parasitic properties. It is the reason I felt the fire in my belly on the runs. There are some studies indicating that after 10-12 days 95% of ppl in the studies that had parasites and took the emulsified oregano oil, well they were now parasite free. Since I am doing all of this preventatively, I want to be extra cautious. Although I have great health insurance, I've found in my life that unless I'm literally dying with something so obvious that a Dr can tell immediately what it is, there is no point in trying to talk to Drs about anything health or wellness related in the USA. They are there for things when they go so wrong and there are no other options. Also the billing system and communication system simple doesn't support these casual types of brainstorming for health and wellness. It's not like we see in old movies and tv shows for most of us where we can just pick up the phone and call our Dr to have a casual, stress free conversation. It's always about them being pressed for their very expensive time. That's what AI is for now since Drs distance themselves from that role decades ago. I have seen what you described from a cat I had for years. That's why I bought bovine Ivermectin a few times before anyone was talking about it during covid. I used it on my dog and cat for decades. For some breeds of dog though it is dangerous (Border Collie, I think)... then with my cat, I did too strong a dose and it began poisoning her and paralyzing her back legs. That stopped when we fixed dose but was scary. I agree completely though: Drs and people should consider deworming themselves if they're at risk.... but ideally they would get lab test first and customize drug and dose to what is found in lab

@hjluks My kind of running bro right here. Is it fun to push&pull and challenge a bit with ppl close to your level sometimes? Sure why not. But even better to just have those low key conversational days where we remember we're in it for the long term. New guy won't make it a month 😂

@QTheEngineer2 If this true (and it wouldn't surprise me, if it is)... then Wow.

@CallahanAutoCo t0 pr0t3ct th13r g@y🐝s?