approach to sickle cell crisis?

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In the north, we have a big population of sickle cell patients who are regulars in the ED for "sickle cell crisis". As a student, I've seen different attendings who teach to treat every sickle cell patient who comes in with complaints of pain (because "they are in pain even though sometimes they do not seem it"), and others who call it b.s. and say they are drug seekers.

What is your approach to SCC in a patient that is hemodynamically stable with baseline labs, and appears well? When do you draw the line and say they are just seeking narcotics? Thanks for the input, just unsure of how to manage these patients correctly..


addendum: nevermind, just saw a recent thread about this!

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In the north, we have a big population of sickle cell patients who are regulars in the ED for "sickle cell crisis". As a student, I've seen different attendings who teach to treat every sickle cell patient who comes in with complaints of pain (because "they are in pain even though sometimes they do not seem it"), and others who call it b.s. and say they are drug seekers.

What is your approach to SCC in a patient that is hemodynamically stable with baseline labs, and appears well? When do you draw the line and say they are just seeking narcotics? Thanks for the input, just unsure of how to manage these patients correctly..


addendum: nevermind, just saw a recent thread about this!

I just treat them. I don't pass judgment, I don't get into wars about the dose of Dilaudid (although I DO have the nurses run it in slow rather than a fast IV push). I simply look up their doses from the last visit/inpatient stay, give them that dose up to 3 times. The minute I write for the third dose, I admit them.
 
I just treat them. I don't pass judgment, I don't get into wars about the dose of Dilaudid (although I DO have the nurses run it in slow rather than a fast IV push). I simply look up their doses from the last visit/inpatient stay, give them that dose up to 3 times. The minute I write for the third dose, I admit them.

i do very similarly... the fights are never worth it and as i tell pts with any legit painful chronic condition - i don't have a pain meter. you tell me if you're well enough to go home... but if you get a 3rd reasonable dose, you probably need admission for better pain control.
 
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same as above, 3 shots and you're admitted for a typical pain crisis (doesn't count as some other complications). Sicklers typically have someone who follows them and takes care of outpt management
 
Whenever I'm questioning a SCD patient's motives, I remind myself that they have a disease that makes them die two or three decades earlier than a non-SCD patient. Then I treat, and if necessary, admit if they're not controlled.
 
Whenever I'm questioning a SCD patient's motives, I remind myself that they have a disease that makes them die two or three decades earlier than a non-SCD patient. Then I treat, and if necessary, admit if they're not controlled.

Yep. I just hydrate, sedate, and narc-em-up.

Get a CBC and a retic. count - see if they need to be transfused. CXR and EKG/trops if they've got chest pain.

Got me thinking, though: back in the days before science really came about; other men in white robes (cough, "holy men", cough), would have pointed to the sickle-cell sufferers and their condition as evidence of demonic possession, condemned the sufferers as "evil people", and probably had them burned at the stake, stoned in the square, or .... whatever.


If that's not enough to get you to think: "Hmm.... maybe this whole religion thing really is bogus, and there's no such thing as angels or demons, god or satan"... then I don't know what will.
 
Got me thinking, though: back in the days before science really came about; other men in white robes (cough, "holy men", cough), would have pointed to the sickle-cell sufferers and their condition as evidence of demonic possession, condemned the sufferers as "evil people", and probably had them burned at the stake, stoned in the square, or .... whatever.


If that's not enough to get you to think: "Hmm.... maybe this whole religion thing really is bogus, and there's no such thing as angels or demons, god or satan"... then I don't know what will.

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Yep. I just hydrate, sedate, and narc-em-up.

Get a CBC and a retic. count - see if they need to be transfused. CXR and EKG/trops if they've got chest pain.

Got me thinking, though: back in the days before science really came about; other men in white robes (cough, "holy men", cough), would have pointed to the sickle-cell sufferers and their condition as evidence of demonic possession, condemned the sufferers as "evil people", and probably had them burned at the stake, stoned in the square, or .... whatever.


If that's not enough to get you to think: "Hmm.... maybe this whole religion thing really is bogus, and there's no such thing as angels or demons, god or satan"... then I don't know what will.

Dude, friendly advice: just can it with the atheistic/rip down the religion thing. As someone told me, atheists can be as annoying as bible thumpers.
 
Dude, friendly advice: just can it with the atheistic/rip down the religion thing. As someone told me, atheists can be as annoying as bible thumpers.

what, you don't enjoy the irony of an atheist preaching/proselytizing?
 
what, you don't enjoy the irony of an atheist preaching/proselytizing?

Well, the aggressively non-religious are just like the aggressively religious (in that the anti-religion thing is like its own religion). Either one leaves me cold.

So, I enjoy it like I enjoy hitting my fingers with a hammer.
 
I just treat them. I don't pass judgment, I don't get into wars about the dose of Dilaudid (although I DO have the nurses run it in slow rather than a fast IV push). I simply look up their doses from the last visit/inpatient stay, give them that dose up to 3 times. The minute I write for the third dose, I admit them.

i do very similarly... the fights are never worth it and as i tell pts with any legit painful chronic condition - i don't have a pain meter. you tell me if you're well enough to go home... but if you get a 3rd reasonable dose, you probably need admission for better pain control.

same as above, 3 shots and you're admitted for a typical pain crisis (doesn't count as some other complications). Sicklers typically have someone who follows them and takes care of outpt management

So I just got around to the August 2012 edition of EM:RAP which addresses this specifically: everything you know about sickle cell is wrong type stuff.

Two therapies commonly used, hydration and oxygen, have been shown to be of no benefit. They recommend euvolemia and O2 only if hypoxic.

The other interesting point they discussed was the "3 shots and admit" policy. The expert on the show stated this was exactly the wrong way to practice (though I've always done it myself, too). I didn't completely buy his alternative, which was to keep them in the department longer (5-6 hours), be very aggressive in titrating the opiates (dilaudid 4mg every 10 min), then discharge them. Maybe this would work in academics, but no way could you use this strategy in the community.
 
He also advocated basically sitting there the whole time and re-dosing yourself. Who has time for that?
 
Interesting that oxygen isn't helpful. I thought that was one of the main physiological underpinnings of crisis and wonder why it doesn't help. I suppose someone has studied that. Can't say I'll be digging in the literature this morning, but it'll be in the queue.
 
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what, you don't enjoy the irony of an atheist preaching/proselytizing?

I'm sorry, g'head. I forgot: willful ignorance is much easier than actual forward thought.

If I told you I had a clue to finding the higgs-boson, there'd be praise all around because that's well-recognized science. Its "irritating" when the clues that I point out that argue against magical thinking cause cognitive dissonance within a group of people.
 
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I'm sorry, g'head. I forgot: willful ignorance is much easier than actual forward thought.

If I told you I had a clue to finding the higgs-boson, there'd be praise all around because that's well-recognized science. Its "irritating" when the clues that I point out that argue against magical thinking cause cognitive dissonance within a group of people.

"...argue against magical thinking cause(s) cognitive dissonance within a group of people."

Hmm...if you didn't say anything, no one would say anything. You keep hewing to a point, answering a question no one is asking. Whether you are saying "Jesus is ALL" or "Jesus is at the MALL" - either one - gets annoying. In other words, I get it. I don't speak for anyone else. And, quite honestly, if you are jibing at me for "magical thinking" and "cognitive dissonance", you could at least direct it at me. I shall clearly disabuse of that notion. In fact, find me exactly 1 (or more, if you can) proseletyzing post that I have put up, and I will publicly eat **** (figuratively). In other words, you can't.
 
I'm sorry, g'head. I forgot: willful ignorance is much easier than actual forward thought.

If I told you I had a clue to finding the higgs-boson, there'd be praise all around because that's well-recognized science. Its "irritating" when the clues that I point out that argue against magical thinking cause cognitive dissonance within a group of people.

I don't think this is what anyone is getting at. What's your end game fox? To make everyone believe what you believe? Isn't that what bothers everyone about the religious nuts? Bringing up their religion out of context just to wave it in your face and talk about how much better off they are because of their beliefs?

People are always going to disagree about these sort of things.
 
Got me thinking, though: back in the days before science really came about; other men in white robes (cough, "holy men", cough), would have pointed to the sickle-cell sufferers and their condition as evidence of demonic possession, condemned the sufferers as "evil people", and probably had them burned at the stake, stoned in the square, or .... whatever.


If that's not enough to get you to think: "Hmm.... maybe this whole religion thing really is bogus, and there's no such thing as angels or demons, god or satan"... then I don't know what will.

And 300 years from now young kids will be learning how these strange quacks called "physicians" used to treat people by sticking needles into their bodies and injecting weird substances into them without any scientific evidence behind it. And they believed that things called "bacteria" and "viruses" caused illness. Our treatments are going to look just as crazy, illogical and 'magical' to future generations as what was done 1000 years ago looks to us today.
 
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"...argue against magical thinking cause(s) cognitive dissonance within a group of people."

Hmm...if you didn't say anything, no one would say anything. You keep hewing to a point, answering a question no one is asking. Whether you are saying "Jesus is ALL" or "Jesus is at the MALL" - either one - gets annoying. In other words, I get it. I don't speak for anyone else. And, quite honestly, if you are jibing at me for "magical thinking" and "cognitive dissonance", you could at least direct it at me. I shall clearly disabuse of that notion. In fact, find me exactly 1 (or more, if you can) proseletyzing post that I have put up, and I will publicly eat **** (figuratively). In other words, you can't.

I don't think this is what anyone is getting at. What's your end game fox? To make everyone believe what you believe? Isn't that what bothers everyone about the religious nuts? Bringing up their religion out of context just to wave it in your face and talk about how much better off they are because of their beliefs?

People are always going to disagree about these sort of things.

Here's my point: What do we do on this forum, day-in and day-out ?

Self-scrutiny.

We all b!tch and moan about detail X, Y, or Z in the world of EM. Be it the unrealistic demands on us by patients, administrators, whatever... or, we take a good, objective look back at our medicine, and figure out "how we can do it better". We laugh at how we "used" to do things and say things like "wow... I can't believe that blind nasotracheal intubation used to be ... it... that's barbaric."

We pour over documents and cite studies and anecdata. We criticize and scrutinize, sharply, our own practices. We say things like - "Well, that study is flawed because of X and Y... and it certainly isn't Z, so we can't really conclude A or B, and we certainly can't practice that way."

I find it frustrating when we, these great learned men and women, can't apply the same logic and reason to the big picture. I find it impossible that we will sit upon high and say things like: "Yes, the BALLSAC study is completely invalid; the statistical analysis is suspect, and the conclusions won't hold up on a larger, multicenter trial", then these same people turn around and say - "Well, religion and holy practices must be respected and upheld because... they're... holy... and stuff." Nobody will pick apart the Bible, the Quran, the Torah, the whatever and say - "Yep, doesn't hold up". Instead, its the "immutable and all-holy word of God!"

My "endgame", if you want, is just to bring this giant contradiction in thought to the attention of anyone who is smart enough to read it, sit back, and say - "Hmm. Yep. I need to apply the same standard that I apply to our profession to other things, too. After all; if its good enough for good science, why should anything else be allowed to 'slide'."

If you're irritated by that, or made uncomfortable by that, then fine; I can't help that. I'll go start my own thread. These moments just strike me so frequently by reading this forum that I can't NOT say something; especially when its as cartoonish as the "white robes (coats) of olde and how they handled disease processes".
 
And 300 years from now young kids will be learning how these strange quacks called "physicians" used to treat people by sticking needles into their bodies and injecting weird substances into them without any scientific evidence behind it. And they believed that things called "bacteria" and "viruses" caused illness. Our treatments are going to look just as crazy, illogical and 'magical' to future generations as what was done 1000 years ago looks to us today.


Thank you. You get it.
 
And 300 years from now young kids will be learning how these strange quacks called "physicians" used to treat people by sticking needles into their bodies and injecting weird substances into them without any scientific evidence behind it. And they believed that things called "bacteria" and "viruses" caused illness. Our treatments are going to look just as crazy, illogical and 'magical' to future generations as what was done 1000 years ago looks to us today.


Although, this..

C'mon, man.
 
Thank you. You get it.

You DON'T get it.

Your obvious manifestation of arrogance and...pride (a spiritual concept that you are proving true as we speak), strengthens my faith in God. Keep it up, the more you talk, the firmer I believe you are clueless and the more your intentions are thwarted.

Go scrutinize yourself.
 
If you are all suggesting our understanding of the universe is only slightly better than the Cro-Magnons, I think you are on to something.

Good job Cro-Magnons. In only 4 billion more years, we will know everything there is to know.


Sincerely,

CEO-Magnon







(This thread is hilarious :laugh: really)
 
Yep. I just hydrate, sedate, and narc-em-up.

Get a CBC and a retic. count - see if they need to be transfused. CXR and EKG/trops if they've got chest pain.

Virtually never get labs on sickle cell patients unless there's something atypical happening.

I don't give IVF unless they're hypovolemic, since over-resuscitation is associated with precipitating acute chest.

I try to achieve 2mg hydromorphone q30 minutes x 3 doses – if they get 6mg in an hour and they're not improving, that's the inflection point for admission. Rarely happens this way with nursing demands and such, but that's the goal.

Have used ketamine in these folks as well with mixed success.
 
OK, perhaps not the greatest example, but the fundamental point remains.

Take a look at physics before Michelson-Morley, and how in roughly 125 years our entire understanding of physics has been radically overturned. I think we are very, very foolish if we think that our understanding of biology - not to mention medicine - will not be changed in a similarly radical manner in the future.

I believe in some absolute, metaphysical truths - but our current "scientific laws" are not among them.

There is an old saying in the academic world "When you get a Bachelor's degree you think you know everything. When you get a Master's degree you realize you know nothing. When you get a Doctorate, you realize you know nothing - but neither does anyone else." You can probably switch that to medicine by substituting "MD, Resident, and Attending."

The point is that I have a healthy disrespect for much of the current medical dogma that is floating around. That is critical for the real world practice of medicine in general and emergency medicine in particular. (Pick your favorite criteria or algorithm) may work well in the aggregate, and may work well 98% of the time, but you have to be aware of those rare occasions when it fails. That is where the indefinable 'art' of medicine takes place, and that is why we will not be replaced in the near future.
 
You DON'T get it.

Your obvious manifestation of arrogance and...pride (a spiritual concept that you are proving true as we speak), strengthens my faith in God. Keep it up, the more you talk, the firmer I believe you are clueless and the more your intentions are thwarted.

Go scrutinize yourself.


Hah. Oh, I get it. I get it just fine.

I scrutinize myself daily. Your "pride is a deadly sin" argument is as real as attributing syncope to "the vapors"; a relic of days gone by. Please tell me that you wouldn't believe that it really IS "the vapors" if you find a 2000+ year old passage "saying so".

You don't have to judge for yourself if I am "clueless" or not; if you can somehow realistically (that's a good word, there) reconcile magical thinking with scientific thinking, then I'll be very interested in what you have to say. If not, I continue to challenge everyone here to play by one and only one set of rules in their lives: either the scientific and the real, or the fantastic and magical. No, you don't get to jump back and forth between the two when it makes you feel good.
 
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If you are all suggesting our understanding of the universe is only slightly better than the Cro-Magnons, I think you are on to something.

Good job Cro-Magnons. In only 4 billion more years, we will know everything there is to know.


Sincerely,

CEO-Magnon



(This thread is hilarious :laugh: really)


You're welcome CEO Magnon. Reminds me of this one thread that I read awhile ago, I forget what it was all about, but the first post said something like - "This forum has become...."

:)
 
The point is that I have a healthy disrespect for much of the current medical dogma that is floating around. That is critical for the real world practice of medicine in general and emergency medicine in particular. (Pick your favorite criteria or algorithm) may work well in the aggregate, and may work well 98% of the time, but you have to be aware of those rare occasions when it fails. That is where the indefinable 'art' of medicine takes place, and that is why we will not be replaced in the near future.

Excellent. This is my point; self-scrutiny and advancement beyond what is held as "dogma" is the way to go. Now, extrapolate: what if we got everyone to move beyond the "dogma" that is held as invariable truth on every corner in these places called "churches", where old men in different white robes spew forth their flavor of "dogma". I mean, how many posthumous "pardons" do they have to hand out to our greatest scientific minds before we step back and say - "I don't believe you. You've got the whole damn thing all wrong."
 
I realize this is off-topic, but have any of you tried fentanyl for acute pain crisis? I've had good success with a small n so far. It acts fast, breaks the pain cycle, and people are usually more than happy to go home with their usual oral meds.
 
RustedFox: +1 :)

Aside from what you already mentioned, I think there's enough overtly religious or quasi-religious pseudoscience infiltrating medicine that suggesting people apply consistent standards cannot happen too much. Especially when they're trying to move in on M.D. territory.
 
Yep. I just hydrate, sedate, and narc-em-up.

Get a CBC and a retic. count - see if they need to be transfused. CXR and EKG/trops if they've got chest pain.

Got me thinking, though: back in the days before science really came about; other men in white robes (cough, "holy men", cough), would have pointed to the sickle-cell sufferers and their condition as evidence of demonic possession, condemned the sufferers as "evil people", and probably had them burned at the stake, stoned in the square, or .... whatever.


If that's not enough to get you to think: "Hmm.... maybe this whole religion thing really is bogus, and there's no such thing as angels or demons, god or satan"... then I don't know what will.

Here's the thing. It's bad enough to have an epic thread derailment. But your post doesn't make sense - let me review it:

1) Invent something which religious people "would have" done centuries ago, of course with no reason to think this ever happened. I mean, you do realize that many religious leaders and "holy men" saw it as their mission to care for their sick and dying, right?

2) Say "if that's enough to get you to think".

3) Profit???

Seriously dude, if you want to post an off topic anti-religious rant, can't you at least base it on something factual? No, your invented scenario is not "enough to get me to think", because you just made it up.
 
OK, perhaps not the greatest example, but the fundamental point remains.

Take a look at physics before Michelson-Morley, and how in roughly 125 years our entire understanding of physics has been radically overturned. I think we are very, very foolish if we think that our understanding of biology - not to mention medicine - will not be changed in a similarly radical manner in the future.

I believe in some absolute, metaphysical truths - but our current "scientific laws" are not among them.

While that's a fair point, I suggest you read Isaac Asimov's essay The Relativity of Wrong.

My answer to him was, "John, when people thought the earth was flat, they were wrong. When people thought the earth was spherical, they were wrong. But if you think that thinking the earth is spherical is just as wrong as thinking the earth is flat, then your view is wronger than both of them put together."
 
Here's the thing. It's bad enough to have an epic thread derailment. But your post doesn't make sense - let me review it:

1) Invent something which religious people "would have" done centuries ago, of course with no reason to think this ever happened. I mean, you do realize that many religious leaders and "holy men" saw it as their mission to care for their sick and dying, right?

2) Say "if that's enough to get you to think".

3) Profit???

Seriously dude, if you want to post an off topic anti-religious rant, can't you at least base it on something factual? No, your invented scenario is not "enough to get me to think", because you just made it up.

Fair enough; I have no actual account of a sickle-cell patient being stoned to death millennia ago. Better yet; a quick google search will give you several accounts of modern-day people whose families tried to perform "exorcisms" on them, to free them of their "homosexual demons". Rewind a couple hundred years; everyone has heard the "Salem Witch Trials" and ergot poisoning story... but... "She's a Witch! Burn her!"

Its not that hard to extrapolate back further, because anything that didn't toe the religious party line way back when was pretty much... yeah, excommunicated, imprisoned, tortured, or killed. Inquisition and crusades, anyone ?

Is it that much of a stretch to think that someone who is overcome by a seemingly invisible source of pain is "possessed" by an evil spirit ?

So, there y'go.

If I get to "heaven"... I'd like to ask Galileo how he felt about his imprisonment, torture, and excommunication by the church. But, he was right, after all.
 
Fair enough; I have no actual account of a sickle-cell patient being stoned to death millennia ago. Better yet; a quick google search will give you several accounts of modern-day people whose families tried to perform "exorcisms" on them, to free them of their "homosexual demons". Rewind a couple hundred years; everyone has heard the "Salem Witch Trials" and ergot poisoning story... but... "She's a Witch! Burn her!"

Its not that hard to extrapolate back further, because anything that didn't toe the religious party line way back when was pretty much... yeah, excommunicated, imprisoned, tortured, or killed. Inquisition and crusades, anyone ?

So, there y'go.

If I get to "heaven"... I'd like to ask Galileo how he felt about his imprisonment, torture, and excommunication by the church. But, he was right, after all.

Of course there are plenty of examples of atrocities committed in the name of religion. But since they have nothing to do with sickle cell disease, I guess they need their own thread.

Here's what Wikipedia has to say about medieval hospitals:

Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick.
...
The Normans brought their hospital system along when they conquered England in 1066. By merging with traditional land-tenure and customs, the new charitable houses became popular and were distinct from both English monasteries and French hospitals. They dispensed alms and some medicine, and were generously endowed by the nobility and gentry who counted on them for spiritual rewards after death.[34]

If that's not enough to get you to think... "Hmmm... I guess religion does have some positive aspects"... then I don't know what will.

Also, minor nitpick: I don't think Galileo was ever tortured by the Church.
 
Of course there are plenty of examples of atrocities committed in the name of religion. But since they have nothing to do with sickle cell disease, I guess they need their own thread.

I offered this already, but... you'd read it here or there, take your pick.

If that's not enough to get you to think... "Hmmm... I guess religion does have some positive aspects"... then I don't know what will.

Also, minor nitpick: I don't think Galileo was ever tortured by the Church.

Yes, I've fielded this argument before; its a good one. We can do all of those positive things without the influence of the church, or any other amalgamation of mystic thought. You don't need a cross, a crescent, a star, or an ohm to be charitable. We don't need adult fairytales to be do-gooders.

Nitpick acknowledged. You get your book, I'll get mine. What matters is the score: Galileo: 6584 Church: 0.
 
Rusted, why did you randomly divert a thread about current EM approaches to sickle cell disease into a rant about religion. It's like a manic patient diverting your history questions in 1-2 steps to their neighbor sue's dog. or a scientologist trying to talk to me on the street, lol (they outnumber the jehovah's witnesses here. If you're so gung ho about your atheism, couldn't you just create a separate topic for it?
 
If you're irritated by that, or made uncomfortable by that, then fine; I can't help that. I'll go start my own thread. These moments just strike me so frequently by reading this forum that I can't NOT say something; especially when its as cartoonish as the "white robes (coats) of olde and how they handled disease processes".

This.

I could create a separate thread, sure. I didn't. Whatever. Those who are going to argue with me are going to argue with me no matter where. I welcome the fight; its why I say the things that I do.
 

Don't give me that, you're more than intelligent enough to control what you post and leave posted on threads (see Birdstrike's numerous "," posts), and you also have more than enough self-control to redirect the conversation to a thread that is meant to debate the endless atheist vs. religion debate a few times already on this thread. As in "why don't I reply to your posts denouncing my views on religion in this X thread I created for just this purpose" =p

Whether you decide to exercise such control is up to you, but don't say you've got no control of it.
 
You're misinterpreting me.

"I can't help that"

... is meant to say - "I can't help your feelings of discomfort or irritation with objectivity and its application in both science and life. I said what I said. If it makes you feel (whatever) then, that's your problem".

I already said: "I'll go start my own thread." I frequently do. I didn't this time. I also didn't think it would be such a big deal. I still might. For the time being, the debate remains right here.
 
I could create a separate thread, sure. I didn't. Whatever. Those who are going to argue with me are going to argue with me no matter where. I welcome the fight; its why I say the things that I do.

1, :rolleyes: you're not welcoming the fight, you're creating it, and then enjoying it when it erupts.
2 Now I see what you're saying. you diverted the thread on purpose instead of just saying that you couldn't help yourself.
3. I'm not peeved that you're belittling religion, I'm more annoyed because I like sickle cell and didn't want the thread diverted from an intellectually stimulating one to an intellectually nauseating (to myself) one.

Anyway, that'll be my last comments here.
 
Don't give me that, you're more than intelligent enough to control what you post and leave posted on threads (see Birdstrike's numerous "," posts), and you also have more than enough self-control to redirect the conversation to a thread that is meant to debate the endless atheist vs. religion debate a few times already on this thread. As in "why don't I reply to your posts denouncing my views on religion in this X thread I created for just this purpose" =p

Whether you decide to exercise such control is up to you, but don't say you've got no control of it.

Hey man I own "," and "."

Don't you even suggest he steal those from me.

He can have " ' " or " ; " but definitely not "." & " , "

:)
 
1, :rolleyes: you're not welcoming the fight, you're creating it, and then enjoying it when it erupts.
2 Now I see what you're saying. you diverted the thread on purpose instead of just saying that you couldn't help yourself.
3. I'm not peeved that you're belittling religion, I'm more annoyed because I like sickle cell and didn't want the thread diverted from an intellectually stimulating one to an intellectually nauseating (to myself) one.

Anyway, that'll be my last comments here.

That's fair. I also "like" the pathology of sickle-cell anemia. Sadly, until we make some serious breakthrus in this area, its the same: hydrate, sedate, transfuse when indicated, narc-up.

Also; I got a post on here somewhere that says: "That's all I do these days; grind shifts and hijack threads."

Is there an ulterior motive ? You (f)ucking bet. I've stated it ten times already: think about what you do. At work. At home. On Sunday morning. It doesn't jive. Play by one set of rules.

Imagine there is no heaven. Its easy, if you try. ...
 
The first thing I do when I encounter someone with Sickle Cell is look in our system to see if they've ever had protein electrophoresis. If they have had it, and aren't true "Disease" but just trait, I tend to do a CBC and kick them out without narcs.

If they haven't had electrophoresis I look back at their labs. If they routinely have high retic counts and a hemoglobin less than 9, I will treat them as a true sickler with fluids, pain meds, etc.

If they have a normal hemoglobin, or normal or low retic count CONSISTENTLY, I treat them as non-sicklers and kick them out.

In this way I have objective criteria about who I give narcotics to.

I applaud the Medical Student for his naive comments. It always gives me a good laugh when someone who has limited clinical experience will lecture me on ethics, and treating pain. Yes we should give people the benefit of the doubt, but when there is evidence that they are fakers (i.e. laughing and eating cheeseburgers) we should aggressively discharge these people.
 
Also; I got a post on here somewhere that says: "That's all I do these days; grind shifts and hijack threads."

Is there an ulterior motive ? You (f)ucking bet. I've stated it ten times already: think about what you do. At work. At home. On Sunday morning. It doesn't jive. Play by one set of rules.

Imagine there is no heaven. Its easy, if you try. ...

It's rare in the EM forum, but not unheard of - if you keep being disruptive, you could be banned. Again, start your own thread, if you like.

As for your (anti)religious diatribes, I don't care if you are saying "Confucius says" or "According to Ganesh" or "Dianetics dictates" or whatever, it is annoying. I said it, and someone else did - you're making something out of nothing. Who is the religious nut about whom you are talking? Who injects religion into every thread? I can't think of who that is. And recall the definition of a fanatic - "someone who can't change their mind, and won't change the subject". That's you, right now, buddy.
 
At least my hijacks are related. Be they about hockey, or houses of worship, they're tangiental, but related. That's good discussion; someone has to stir the pot.

I'm just keeping it Real. Back to your regularly scheduled thread.
 
It's rare in the EM forum, but not unheard of - if you keep being disruptive, you could be banned. Again, start your own thread, if you like.

As for your (anti)religious diatribes, I don't care if you are saying "Confucius says" or "According to Ganesh" or "Dianetics dictates" or whatever, it is annoying. I said it, and someone else did - you're making something out of nothing. Who is the religious nut about whom you are talking? Who injects religion into every thread? I can't think of who that is. And recall the definition of a fanatic - "someone who can't change their mind, and won't change the subject". That's you, right now, buddy.

Sickle cell anemia patients have a bad disease. They are sick. Be glad you don't have their disease. Treat them as such.
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FWIW, I don't think Rustedfox should be banned. As far as being banned, it's a complete mystery as to what gets someone banned on SDN. Someone just got banned on the Gas forum. No one can figure out why. If fact, some forums have tons of banned people and you go through their old threads and you can never find anything crazy, spam, hate speech etc. After 1,000 posts the guy gets banned? In fact, I'm sure it's a matter of time before I get banned. Probably Apollyon, too. For what, I don't know.

As far as the atheist vs. religion thing I have a couple comments. This is not directed at rusted fox or anyone else on here, because no one on this forum has offended me (not since mineraleq....or whatever his name was last spring). I'm speaking in general.

Atheists can be as militant as people who are religiously militant. My post that I first put here about the Sandy Hook shooting, a few people liked, most ignored it. I've written much better posts; I've written worse. (I don't know if it's still up or not). Maybe some people thought it was stupid. Regardless, few cared enough to comment on it, either way (accept a few studs who gave :thumbup: , you know who you are!) But KevinPho accepted it as a guest post on his blog and the atheists go off in the comments, because I used the word, "evil," and because of that I'm some sort of religious nut, and as a doctor I should know the guy was "mentally ill" as if that's a specific diagnosis, and as a doctor I should know better that obviously this mass murderer had no control over his actions, didn't know what he was doing was wrong, and is excused because he had Asperger's and had no free will to decide to plan an attack, cover his tracks by smashing his hard drive, shooting his Mom in her sleep, and then methodically shooting a bunch of kids instead of just himself. By the way, I did not pick the title, Pho changed my title.

http://www.kevinmd.com/blog/2012/12/words-explain-sandy-hook-pure-evil.html

First of all, the term evil, can be used in a completely generic, and non-religious context. I pointed that out in the comments but, this one commenter just kep coming back, enough that now I think he was just trolling to annoy me. For all he knows, I could be an atheist myself. Then he comes back and says, he read my other posts and they are "religious based". What? Because in my post "Those Shoes" I used the term OMG? That makes my posts "religious based"?

There is an entire argument called, "The problem of evil," which (to make a very long philosophical discussion very short) involves atheists accepting the completely atheistic view of "evil," using the term themselves and hinging their entire argument to prove God doesn't exist on what they consider an unarguable fact, that "evil" whatever it is, does exist (in their opinion, in the absence of God).

http://www.existence-of-god.com/problem-of-evil.html

So a few of you stand up SDNers went over there to back me up with this guy (EM2BE, you rock!) who had me pegged as a religious nut, because I used the term "evil," and therefore decided that any thing I've ever said and written has to be discredited because, using the word "evil" which even atheist philosophers use, means I'm a religious nut that must have a secret religious agenda that I'm secretly using to "judge" my patients. As if the Sandy Hook shooter was my patient, and I can't judge his mass murdering actions, because having Asperger's and depression absolves someone of the responsibility of murdering people.

So my point is that people need to chill. That's why I made the cro-magnon comment to diffuse the situation. When people start talking religion, atheism or even think someone else is talking about religion, or lack thereof, they get totally irrational in their sincere efforts to be rational.

So I don't think rustedfox should even remotely be considered for a ban over this, but I do think people just need to chill. If someone even so much as throws out a term with a religious or atheist connotation people freak out and go Cro-magnon.

Now I know to not even throw out a word that might even have a potential religious connotation, without necessarily even using it as such.

That's why some people say, never discuss religion or politics.
 
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Heh. That was my thousandth post. I didn't even recognize it until you said something. Thanks, Birdstrike.
 
Heh. That was my thousandth post. I didn't even recognize it until you said something. Thanks, Birdstrike.

Doctor712, also. >1000 posts.

http://forums.studentdoctor.net/showthread.php?p=13529920


Any minute, you'll be gone. Goodbye rusted fox. Nice knowing ya.

As for me, 135 more posts before I'm off'd. I'm gonna enjoy every single one of them. And I'm gonna make them extra long and painful. 20 pages each, with 50 links to click on.

:D
 
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i was banned from a spine forum b/c i called the moderator out on his ridiculous BS self-aggrandizing propaganda that was medically not sound.... so you never know what buttons someone has ;)
 
Doctor712, also. >1000 posts.

http://forums.studentdoctor.net/showthread.php?p=13529920


Any minute, you'll be gone. Goodbye rusted fox. Nice knowing ya.

As for me, 135 more posts before I'm off'd. I'm gonna enjoy every single one of them. And I'm gonna make them extra long and painful. 20 pages each, with 50 links to click on.

:D

My own, personal, opinion? "Doctor"712? Got what he deserved. That was not a spur of the moment, impulsive thing. And I am not the only one - by ANY stretch - that feels this way.
 
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