Hi, I am relatively new to statistics. I have a sample with 2218 individulals and I am looking at predictors of bone mineral density which is a continuous variable in a linear regression model using JMP. I am including age, sex, BMI, vitamin D level, renal function, PTH, dairy intake, loop diuretics (yes/no), thiazides (yes/no) and warfarin use (yes/no) in the model. The other medications have hundreds of users, but there are only 70 warfarin users. Is my model overfitted to draw conclusions about warfarin and bone mineral density? I know if warfarin were the outcome variable and bone mineral density was one of the independent variables, I could use logistic regression and then the "one in ten rule" would mean I should only adjust for 7 variables. However I am not sure how this would apply or how many variables I can adjust for in a linear regression. I very much appreciate any help.

ECA Stack - Dopamine Enhancing Routine/Cycle
ECA, which stands for Ephedrine, Caffeine, and Aspirin, is a combination of these three compounds commonly used for its potential synergistic effects on fat loss and neural stimulation. Avoid the use of Ephedrine if at all possible, if you do decide to use it, please do additional research and talk to a professional before you make the decision. Caffeine alone should suffice, and with the techniques outlined below the natural dopamine production will be much more beneficial, maintainable and with far fewer risks or side effects.
ECA Stack – Dopamine / Energy Level Boosting Effects
The ECA stack is a combination of ephedrine, caffeine, and aspirin that is often used as a dietary supplement or performance-enhancing aid. It is named after the initials of its components. The stack is believed to promote weight loss, enhance energy levels, and improve athletic performance. Let's take a closer look at each component and their effects, particularly in relation to dopamine.
Ephedrine, a sympathomimetic amine, acts as a stimulant and bronchodilator. It affects various neurotransmitters in the brain, including dopamine. Ephedrine increases dopamine release by acting as a substrate for the dopamine transporter (DAT) protein. It competes with dopamine for uptake by the DAT, resulting in increased dopamine levels in the synapse and prolonging its effects. Additionally, ephedrine can stimulate dopamine release by activating adrenergic receptors and promoting the release of dopamine from the presynaptic neuron. The increased dopamine levels can lead to increased alertness, enhanced mood, and potential euphoria.
Caffeine, a naturally occurring stimulant, is known for its effects on alertness and wakefulness. It primarily works by blocking adenosine receptors in the brain, which inhibits the sleep-promoting effects of adenosine. This blockade indirectly affects dopamine levels by reducing the inhibitory effect of adenosine on dopamine release. Consequently, caffeine increases dopamine release in certain brain regions, leading to heightened arousal, improved mood, and enhanced cognitive function. However, it's important to note that caffeine's effects on dopamine are relatively mild compared to drugs that directly target dopamine receptors and transporters.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), primarily acts on the prostaglandin pathway and has analgesic and anti-inflammatory properties. While aspirin does not directly interact with dopamine receptors or transporters, it can indirectly influence dopamine levels through its effects on other neurotransmitter systems. For instance, by inhibiting prostaglandin production and reducing inflammation, aspirin may indirectly impact dopamine signaling. Additionally, the relief of pain achieved through aspirin's analgesic properties can affect dopamine release and potentially influence mood and motivation.
The ECA stack, as a combination of ephedrine, caffeine, and aspirin, is believed to work synergistically to enhance its effects. Ephedrine and caffeine can both increase dopamine levels, resulting in increased alertness, improved mood, and heightened energy. Aspirin, while not directly affecting dopamine, can indirectly support dopamine function by reducing inflammation and promoting comfort.
Interactions with other Medication

1. Blood Pressure Medications: Ephedrine and caffeine can both increase blood pressure and heart rate. If you are taking medications for high blood pressure, such as beta-blockers or calcium channel blockers, combining them with the ECA stack may interfere with the effectiveness of these medications or lead to excessive cardiovascular stimulation.
2. Stimulant Medications: The combination of ephedrine and caffeine in the ECA stack can have stimulant effects on the central nervous system. If you are taking other stimulant medications, such as amphetamines or methylphenidate, combining them with the ECA stack may increase the risk of side effects, such as increased heart rate, elevated blood pressure, and nervousness.
3. Antidepressants: Some antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), can affect the metabolism and clearance of ephedrine and caffeine. Combining these medications with the ECA stack may increase the risk of adverse effects, including serotonin syndrome, high blood pressure, and rapid heart rate.
4. Anticoagulants/Antiplatelet Medications: Aspirin, one component of the ECA stack, is an antiplatelet medication that can thin the blood and increase the risk of bleeding. Combining aspirin with other anticoagulant or antiplatelet medications, such as warfarin or clopidogrel, may potentiate the blood-thinning effects and increase the risk of bleeding complications.
5. Thyroid Medications: Ephedrine, a sympathomimetic amine, can potentially interact with thyroid medications, such as levothyroxine. Ephedrine may increase the release of thyroid hormones or interfere with their metabolism, leading to altered thyroid function and potential side effects.

Suggested Routine to naturally boost dopamine levels
​

1. Morning:

• Start the day with 30 minutes of moderate-intensity exercise, such as a brisk walk or a workout routine. This can help increase dopamine levels and promote overall well-being.
• Consume a balanced breakfast that includes foods rich in tyrosine, such as eggs, lean meats, or legumes. Include fruits or vegetables for added antioxidants.

​

1. Daytime:

• Throughout the day, practice stress management techniques whenever needed. Take short breaks to engage in deep breathing exercises, meditation, or mindfulness to reduce stress levels and support dopamine balance.
• Stay hydrated and consider replacing caffeinated beverages with herbal tea or water.

​

1. Afternoon:

• Take a break for creative activities or hobbies that bring you joy. This can include listening to music, painting, writing, or engaging in any other creative pursuits that stimulate dopamine release.

​

1. Evening:

• Allocate time for socializing with friends or loved ones. Plan activities like going for a walk together, having a meal, or engaging in meaningful conversations that promote positive social interactions and support dopamine levels.

1. Night:

• Before bedtime, create a calm and conducive environment for quality sleep. Establish a regular sleep schedule and aim for 7-9 hours of uninterrupted sleep. Avoid the use of caffeine or ephedrine in the evening, as they may interfere with sleep quality and dopamine regulation.

Dopamine Enhancing Dietary Overview
​

1. Proteins: Foods rich in proteins provide the necessary building blocks for dopamine synthesis. Include lean meats, poultry, fish, eggs, tofu, legumes, and dairy products in your diet.
2. Tyrosine-rich foods: Tyrosine is an amino acid involved in dopamine synthesis. Foods such as almonds, avocados, bananas, eggs, chicken, and turkey are good sources of tyrosine.
3. Leafy greens: Dark leafy greens like spinach, kale, and collard greens contain high levels of folate. Folate is important for neurotransmitter synthesis, including dopamine.
4. Fruits and vegetables: Berries, particularly blueberries, are rich in antioxidants and may have neuroprotective effects, promoting brain health. Other fruits and vegetables, such as oranges, tomatoes, and bell peppers, provide essential vitamins and minerals that support dopamine function.
5. Nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are rich in nutrients like magnesium, zinc, and omega-3 fatty acids, which are beneficial for brain health and neurotransmitter function.
6. Dark chocolate: Dark chocolate contains compounds like flavonoids and phenylethylamine (PEA), which may help enhance mood and support dopamine release. Choose dark chocolate with a high cocoa content (70% or higher) and consume in moderation.
7. Green tea: Green tea contains an amino acid called L-theanine, which has been shown to have a positive impact on dopamine levels and brain function. It can promote relaxation while enhancing alertness.
8. Turmeric: Turmeric contains curcumin, a compound known for its anti-inflammatory and antioxidant properties. It may help protect dopamine-producing neurons and support overall brain health.
9. Probiotic-rich foods: Emerging research suggests a link between gut health and dopamine production. Including fermented foods like yogurt, sauerkraut, kimchi, and kefir in your diet can support a healthy gut microbiome, which may indirectly influence dopamine levels.
10. Water: Staying hydrated is essential for optimal brain function, including neurotransmitter synthesis and release. Make sure to drink an adequate amount of water throughout the day.

Several vitamins play a role in the synthesis, regulation, and function of dopamine in the brain.
​

1. Vitamin B6 (Pyridoxine): Vitamin B6 is involved in the conversion of the amino acid L-tyrosine into dopamine. It is a co-factor for the enzyme aromatic L-amino acid decarboxylase, which helps convert L-tyrosine to L-DOPA, a precursor of dopamine.
2. Vitamin B9 (Folate): Folate is important for the synthesis and metabolism of neurotransmitters, including dopamine. It participates in the conversion of L-DOPA to dopamine through its role in one-carbon metabolism.
3. Vitamin B12 (Cobalamin): Vitamin B12 is involved in the formation of myelin sheaths, which protect nerve cells, including dopaminergic neurons. It also plays a role in the synthesis and maintenance of neurotransmitters, including dopamine.
4. Vitamin D: Vitamin D receptors are found in various brain regions, including those involved in dopamine synthesis and regulation. Vitamin D deficiency has been linked to altered dopamine signaling and neurotransmission.
5. Vitamin C: Vitamin C is an antioxidant that helps protect dopamine neurons from oxidative stress. It is involved in the biosynthesis of dopamine by acting as a cofactor for the enzyme dopamine β-hydroxylase.
6. Vitamin E: Vitamin E is an antioxidant that protects dopamine neurons from oxidative damage. It helps maintain the integrity and function of dopaminergic neurons.

Other Considerations: Enhance and Maintain dopamine levels
​

1. Regular exercise: Engaging in aerobic exercises like running, swimming, or cycling can stimulate dopamine release and promote overall brain health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
2. Get enough sleep: Quality sleep is essential for proper neurotransmitter function, including dopamine regulation. Aim for 7-9 hours of uninterrupted sleep each night to support optimal brain health.
3. Manage stress: Chronic stress can negatively impact dopamine levels. Explore stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.
4. Listen to music: Listening to music you love can induce pleasure and increase dopamine release. Choose music that uplifts your mood and makes you feel good.
5. Set and achieve goals: Accomplishing goals, both big and small, can activate the brain's reward pathways and boost dopamine levels. Break larger goals into smaller, achievable tasks to experience a sense of accomplishment along the way.
6. Practice mindfulness: Mindfulness exercises, such as meditation or mindful breathing, can help improve dopamine receptor sensitivity and enhance overall well-being.
7. Spend time in nature: Being in nature has been shown to have a positive impact on mood and overall brain health. Take walks in green spaces, go hiking, or simply spend time outdoors to potentially increase dopamine levels.
8. Socialize and connect: Engaging in meaningful social interactions, spending time with loved ones, and nurturing relationships can stimulate dopamine release and promote feelings of happiness and well-being.
9. Seek pleasurable experiences: Engage in activities that bring you joy and pleasure, whether it's playing a musical instrument, dancing, painting, or engaging in hobbies you are passionate about. Enjoying pleasurable experiences can enhance dopamine release.
10. Limit excessive dopamine-depleting behaviors: Certain behaviors like excessive consumption of alcohol, drug use, and excessive gambling can deplete dopamine levels over time. Moderation and balance are key.

Combating Weight Loss (If Needed)
While there are numerous meal replacement brands available worldwide, here are 10 well-known and popular brands that offer carb-intensive meal replacement options:
​

1. Soylent: Soylent offers a range of meal replacement products, including their original formula, which provides a balanced mix of carbohydrates, proteins, and fats.
2. Huel: Huel offers complete meal replacements in powder form, with options that include a significant amount of carbohydrates, sourced from oats and other ingredients.
3. Ample: Ample provides meal replacement shakes made from real food ingredients, including carbohydrates from sources like oats, sweet potato, and tapioca.
4. Garden of Life: Garden of Life offers meal replacement powders and shakes that are rich in carbohydrates, often derived from organic whole food sources like oats, quinoa, and fruits.
5. Orgain: Orgain produces organic meal replacement shakes that contain carbohydrates from ingredients such as brown rice, fruits, and vegetables.
6. Kate Farms: Kate Farms offers plant-based meal replacement shakes that provide a balance of macronutrients, including carbohydrates from organic pea protein and brown rice.
7. Vega: Vega offers a range of plant-based meal replacement shakes and powders that contain carbohydrates from sources like organic sprouted brown rice and organic quinoa.
8. Ensure: Ensure is a well-known brand that offers meal replacement shakes designed for nutrition and energy, with carbohydrate-rich options available.
9. SlimFast: SlimFast offers a variety of meal replacement shakes and bars, including carb-conscious options that provide a controlled amount of carbohydrates for those watching their carb intake.
10. Atkins: While primarily known for their low-carb products, Atkins also offers meal replacement shakes and bars with a focus on controlled carbohydrate intake.

Hi everyone, I’m sure this is common amongst the group but I need advice. About 3x a year, pretty much as a season changes, I get serious pain like a crick in my neck. The typical route for this “Crick“ is that it will start with tightness in my neck/shoulder, making it difficult to move my head, but then will move down and under my shoulder blade back up the underside of my arm, and then cause pain down my arm, resulting in tingling and lack of sensation in my fingers. Typically, this is accompanied by pericarditis and tight pain in my chest that will come and go. It is pretty severe as well, colchicine helps with that part. But, I don’t know if the two are related.
This has been going on for about two years and it lasts for months, once it starts. It makes work so difficult and life so unbearable. I’ve seen doctors and at one point they try to prescribe gabapentin, but I really didn’t want to use that. because of warfarin, I can’t take ibuprofen and I just don’t know what I can do to help this. It’s starting again right now and I want to try and stop it and it’s tracks before it ends up with my whole arm being numb for months on end. Does anybody else have any suggestions on what they do for this? Ice, heat, mineral baths, hot showers… I tried a lot of things, rotation and exercise, but none of it seems to last more than a couple of minutes in relief.

Feelings drained, that coffee/energy drink not hitting like it use to? Do you wake up wanting to murder someone until you have your pot of coffee?
I developed a guide to enhance dopamine levels naturally and un-naturally, stop relying on your phone to feel alive, cultivate other methods of dopamine production or just add some synthetic adrenaline (Ephedrine) to spice things up (Be sure to cycle this supplement). This guide can help you lose weight while boosting energy levels and overall mood, if weight is not an issue in your life meal replacement suggestions were added to the end of this post and will compensate as increase in dopamine stimulation will suppress apatite.
​
ECA Stack - Dopamine Enhancing Routine/Cycle
ECA, which stands for Ephedrine, Caffeine, and Aspirin, is a combination of these three compounds commonly used for its potential synergistic effects on fat loss and neural stimulation. Avoid the use of Ephedrine if at all possible, if you do decide to use it, please do additional research and talk to a professional before you make the decision. Caffeine alone should suffice, and with the techniques outlined below the natural dopamine production will be much more beneficial, maintainable and with far fewer risks or side effects.
ECA Stack – Dopamine / Energy Level Boosting Effects
The ECA stack is a combination of ephedrine, caffeine, and aspirin that is often used as a dietary supplement or performance-enhancing aid. It is named after the initials of its components. The stack is believed to promote weight loss, enhance energy levels, and improve athletic performance. Let's take a closer look at each component and their effects, particularly in relation to dopamine.
Ephedrine, a sympathomimetic amine, acts as a stimulant and bronchodilator. It affects various neurotransmitters in the brain, including dopamine. Ephedrine increases dopamine release by acting as a substrate for the dopamine transporter (DAT) protein. It competes with dopamine for uptake by the DAT, resulting in increased dopamine levels in the synapse and prolonging its effects. Additionally, ephedrine can stimulate dopamine release by activating adrenergic receptors and promoting the release of dopamine from the presynaptic neuron. The increased dopamine levels can lead to increased alertness, enhanced mood, and potential euphoria.
Caffeine, a naturally occurring stimulant, is known for its effects on alertness and wakefulness. It primarily works by blocking adenosine receptors in the brain, which inhibits the sleep-promoting effects of adenosine. This blockade indirectly affects dopamine levels by reducing the inhibitory effect of adenosine on dopamine release. Consequently, caffeine increases dopamine release in certain brain regions, leading to heightened arousal, improved mood, and enhanced cognitive function. However, it's important to note that caffeine's effects on dopamine are relatively mild compared to drugs that directly target dopamine receptors and transporters.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), primarily acts on the prostaglandin pathway and has analgesic and anti-inflammatory properties. While aspirin does not directly interact with dopamine receptors or transporters, it can indirectly influence dopamine levels through its effects on other neurotransmitter systems. For instance, by inhibiting prostaglandin production and reducing inflammation, aspirin may indirectly impact dopamine signaling. Additionally, the relief of pain achieved through aspirin's analgesic properties can affect dopamine release and potentially influence mood and motivation.
The ECA stack, as a combination of ephedrine, caffeine, and aspirin, is believed to work synergistically to enhance its effects. Ephedrine and caffeine can both increase dopamine levels, resulting in increased alertness, improved mood, and heightened energy. Aspirin, while not directly affecting dopamine, can indirectly support dopamine function by reducing inflammation and promoting comfort.
Interactions with other Medication

1. Blood Pressure Medications: Ephedrine and caffeine can both increase blood pressure and heart rate. If you are taking medications for high blood pressure, such as beta-blockers or calcium channel blockers, combining them with the ECA stack may interfere with the effectiveness of these medications or lead to excessive cardiovascular stimulation.
2. Stimulant Medications: The combination of ephedrine and caffeine in the ECA stack can have stimulant effects on the central nervous system. If you are taking other stimulant medications, such as amphetamines or methylphenidate, combining them with the ECA stack may increase the risk of side effects, such as increased heart rate, elevated blood pressure, and nervousness.
3. Antidepressants: Some antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), can affect the metabolism and clearance of ephedrine and caffeine. Combining these medications with the ECA stack may increase the risk of adverse effects, including serotonin syndrome, high blood pressure, and rapid heart rate.
4. Anticoagulants/Antiplatelet Medications: Aspirin, one component of the ECA stack, is an antiplatelet medication that can thin the blood and increase the risk of bleeding. Combining aspirin with other anticoagulant or antiplatelet medications, such as warfarin or clopidogrel, may potentiate the blood-thinning effects and increase the risk of bleeding complications.
5. Thyroid Medications: Ephedrine, a sympathomimetic amine, can potentially interact with thyroid medications, such as levothyroxine. Ephedrine may increase the release of thyroid hormones or interfere with their metabolism, leading to altered thyroid function and potential side effects.

Suggested Routine to naturally boost dopamine levels
​

1. Morning:

• Start the day with 30 minutes of moderate-intensity exercise, such as a brisk walk or a workout routine. This can help increase dopamine levels and promote overall well-being.
• Consume a balanced breakfast that includes foods rich in tyrosine, such as eggs, lean meats, or legumes. Include fruits or vegetables for added antioxidants.

​

1. Daytime:

• Throughout the day, practice stress management techniques whenever needed. Take short breaks to engage in deep breathing exercises, meditation, or mindfulness to reduce stress levels and support dopamine balance.
• Stay hydrated and consider replacing caffeinated beverages with herbal tea or water.

​

1. Afternoon:

• Take a break for creative activities or hobbies that bring you joy. This can include listening to music, painting, writing, or engaging in any other creative pursuits that stimulate dopamine release.

​

1. Evening:

• Allocate time for socializing with friends or loved ones. Plan activities like going for a walk together, having a meal, or engaging in meaningful conversations that promote positive social interactions and support dopamine levels.

1. Night:

• Before bedtime, create a calm and conducive environment for quality sleep. Establish a regular sleep schedule and aim for 7-9 hours of uninterrupted sleep. Avoid the use of caffeine or ephedrine in the evening, as they may interfere with sleep quality and dopamine regulation.

Dopamine Enhancing Dietary Overview
​

1. Proteins: Foods rich in proteins provide the necessary building blocks for dopamine synthesis. Include lean meats, poultry, fish, eggs, tofu, legumes, and dairy products in your diet.
2. Tyrosine-rich foods: Tyrosine is an amino acid involved in dopamine synthesis. Foods such as almonds, avocados, bananas, eggs, chicken, and turkey are good sources of tyrosine.
3. Leafy greens: Dark leafy greens like spinach, kale, and collard greens contain high levels of folate. Folate is important for neurotransmitter synthesis, including dopamine.
4. Fruits and vegetables: Berries, particularly blueberries, are rich in antioxidants and may have neuroprotective effects, promoting brain health. Other fruits and vegetables, such as oranges, tomatoes, and bell peppers, provide essential vitamins and minerals that support dopamine function.
5. Nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are rich in nutrients like magnesium, zinc, and omega-3 fatty acids, which are beneficial for brain health and neurotransmitter function.
6. Dark chocolate: Dark chocolate contains compounds like flavonoids and phenylethylamine (PEA), which may help enhance mood and support dopamine release. Choose dark chocolate with a high cocoa content (70% or higher) and consume in moderation.
7. Green tea: Green tea contains an amino acid called L-theanine, which has been shown to have a positive impact on dopamine levels and brain function. It can promote relaxation while enhancing alertness.
8. Turmeric: Turmeric contains curcumin, a compound known for its anti-inflammatory and antioxidant properties. It may help protect dopamine-producing neurons and support overall brain health.
9. Probiotic-rich foods: Emerging research suggests a link between gut health and dopamine production. Including fermented foods like yogurt, sauerkraut, kimchi, and kefir in your diet can support a healthy gut microbiome, which may indirectly influence dopamine levels.
10. Water: Staying hydrated is essential for optimal brain function, including neurotransmitter synthesis and release. Make sure to drink an adequate amount of water throughout the day.

Several vitamins play a role in the synthesis, regulation, and function of dopamine in the brain.
​

1. Vitamin B6 (Pyridoxine): Vitamin B6 is involved in the conversion of the amino acid L-tyrosine into dopamine. It is a co-factor for the enzyme aromatic L-amino acid decarboxylase, which helps convert L-tyrosine to L-DOPA, a precursor of dopamine.
2. Vitamin B9 (Folate): Folate is important for the synthesis and metabolism of neurotransmitters, including dopamine. It participates in the conversion of L-DOPA to dopamine through its role in one-carbon metabolism.
3. Vitamin B12 (Cobalamin): Vitamin B12 is involved in the formation of myelin sheaths, which protect nerve cells, including dopaminergic neurons. It also plays a role in the synthesis and maintenance of neurotransmitters, including dopamine.
4. Vitamin D: Vitamin D receptors are found in various brain regions, including those involved in dopamine synthesis and regulation. Vitamin D deficiency has been linked to altered dopamine signaling and neurotransmission.
5. Vitamin C: Vitamin C is an antioxidant that helps protect dopamine neurons from oxidative stress. It is involved in the biosynthesis of dopamine by acting as a cofactor for the enzyme dopamine β-hydroxylase.
6. Vitamin E: Vitamin E is an antioxidant that protects dopamine neurons from oxidative damage. It helps maintain the integrity and function of dopaminergic neurons.

Other Considerations: Enhance and Maintain dopamine levels
​

1. Regular exercise: Engaging in aerobic exercises like running, swimming, or cycling can stimulate dopamine release and promote overall brain health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
2. Get enough sleep: Quality sleep is essential for proper neurotransmitter function, including dopamine regulation. Aim for 7-9 hours of uninterrupted sleep each night to support optimal brain health.
3. Manage stress: Chronic stress can negatively impact dopamine levels. Explore stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.
4. Listen to music: Listening to music you love can induce pleasure and increase dopamine release. Choose music that uplifts your mood and makes you feel good.
5. Set and achieve goals: Accomplishing goals, both big and small, can activate the brain's reward pathways and boost dopamine levels. Break larger goals into smaller, achievable tasks to experience a sense of accomplishment along the way.
6. Practice mindfulness: Mindfulness exercises, such as meditation or mindful breathing, can help improve dopamine receptor sensitivity and enhance overall well-being.
7. Spend time in nature: Being in nature has been shown to have a positive impact on mood and overall brain health. Take walks in green spaces, go hiking, or simply spend time outdoors to potentially increase dopamine levels.
8. Socialize and connect: Engaging in meaningful social interactions, spending time with loved ones, and nurturing relationships can stimulate dopamine release and promote feelings of happiness and well-being.
9. Seek pleasurable experiences: Engage in activities that bring you joy and pleasure, whether it's playing a musical instrument, dancing, painting, or engaging in hobbies you are passionate about. Enjoying pleasurable experiences can enhance dopamine release.
10. Limit excessive dopamine-depleting behaviors: Certain behaviors like excessive consumption of alcohol, drug use, and excessive gambling can deplete dopamine levels over time. Moderation and balance are key.

Combating Weight Loss (If Needed)
While there are numerous meal replacement brands available worldwide, here are 10 well-known and popular brands that offer carb-intensive meal replacement options:
​

1. Soylent: Soylent offers a range of meal replacement products, including their original formula, which provides a balanced mix of carbohydrates, proteins, and fats.
2. Huel: Huel offers complete meal replacements in powder form, with options that include a significant amount of carbohydrates, sourced from oats and other ingredients.
3. Ample: Ample provides meal replacement shakes made from real food ingredients, including carbohydrates from sources like oats, sweet potato, and tapioca.
4. Garden of Life: Garden of Life offers meal replacement powders and shakes that are rich in carbohydrates, often derived from organic whole food sources like oats, quinoa, and fruits.
5. Orgain: Orgain produces organic meal replacement shakes that contain carbohydrates from ingredients such as brown rice, fruits, and vegetables.
6. Kate Farms: Kate Farms offers plant-based meal replacement shakes that provide a balance of macronutrients, including carbohydrates from organic pea protein and brown rice.
7. Vega: Vega offers a range of plant-based meal replacement shakes and powders that contain carbohydrates from sources like organic sprouted brown rice and organic quinoa.
8. Ensure: Ensure is a well-known brand that offers meal replacement shakes designed for nutrition and energy, with carbohydrate-rich options available.
9. SlimFast: SlimFast offers a variety of meal replacement shakes and bars, including carb-conscious options that provide a controlled amount of carbohydrates for those watching their carb intake.
10. Atkins: While primarily known for their low-carb products, Atkins also offers meal replacement shakes and bars with a focus on controlled carbohydrate intake.

Expired a year ago. I can’t afford this supplement normally but it has a lot of things I’d want in it. Do you think it would be risky to take?

ECA Stack - Dopamine Enhancing Routine/Cycle
ECA, which stands for Ephedrine, Caffeine, and Aspirin, is a combination of these three compounds commonly used for its potential synergistic effects on fat loss and neural stimulation. Avoid the use of Ephedrine if at all possible, if you do decide to use it, please do additional research and talk to a professional before you make the decision. Caffeine alone should suffice, and with the techniques outlined below the natural dopamine production will be much more beneficial, maintainable and with far fewer risks or side effects.
ECA Stack – Dopamine / Energy Level Boosting Effects
The ECA stack is a combination of ephedrine, caffeine, and aspirin that is often used as a dietary supplement or performance-enhancing aid. It is named after the initials of its components. The stack is believed to promote weight loss, enhance energy levels, and improve athletic performance. Let's take a closer look at each component and their effects, particularly in relation to dopamine.
Ephedrine, a sympathomimetic amine, acts as a stimulant and bronchodilator. It affects various neurotransmitters in the brain, including dopamine. Ephedrine increases dopamine release by acting as a substrate for the dopamine transporter (DAT) protein. It competes with dopamine for uptake by the DAT, resulting in increased dopamine levels in the synapse and prolonging its effects. Additionally, ephedrine can stimulate dopamine release by activating adrenergic receptors and promoting the release of dopamine from the presynaptic neuron. The increased dopamine levels can lead to increased alertness, enhanced mood, and potential euphoria.
Caffeine, a naturally occurring stimulant, is known for its effects on alertness and wakefulness. It primarily works by blocking adenosine receptors in the brain, which inhibits the sleep-promoting effects of adenosine. This blockade indirectly affects dopamine levels by reducing the inhibitory effect of adenosine on dopamine release. Consequently, caffeine increases dopamine release in certain brain regions, leading to heightened arousal, improved mood, and enhanced cognitive function. However, it's important to note that caffeine's effects on dopamine are relatively mild compared to drugs that directly target dopamine receptors and transporters.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), primarily acts on the prostaglandin pathway and has analgesic and anti-inflammatory properties. While aspirin does not directly interact with dopamine receptors or transporters, it can indirectly influence dopamine levels through its effects on other neurotransmitter systems. For instance, by inhibiting prostaglandin production and reducing inflammation, aspirin may indirectly impact dopamine signaling. Additionally, the relief of pain achieved through aspirin's analgesic properties can affect dopamine release and potentially influence mood and motivation.
The ECA stack, as a combination of ephedrine, caffeine, and aspirin, is believed to work synergistically to enhance its effects. Ephedrine and caffeine can both increase dopamine levels, resulting in increased alertness, improved mood, and heightened energy. Aspirin, while not directly affecting dopamine, can indirectly support dopamine function by reducing inflammation and promoting comfort.
Interactions with other Medication

1. Blood Pressure Medications: Ephedrine and caffeine can both increase blood pressure and heart rate. If you are taking medications for high blood pressure, such as beta-blockers or calcium channel blockers, combining them with the ECA stack may interfere with the effectiveness of these medications or lead to excessive cardiovascular stimulation.
   
2. Stimulant Medications: The combination of ephedrine and caffeine in the ECA stack can have stimulant effects on the central nervous system. If you are taking other stimulant medications, such as amphetamines or methylphenidate, combining them with the ECA stack may increase the risk of side effects, such as increased heart rate, elevated blood pressure, and nervousness.
   
3. Antidepressants: Some antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), can affect the metabolism and clearance of ephedrine and caffeine. Combining these medications with the ECA stack may increase the risk of adverse effects, including serotonin syndrome, high blood pressure, and rapid heart rate.
   
4. Anticoagulants/Antiplatelet Medications: Aspirin, one component of the ECA stack, is an antiplatelet medication that can thin the blood and increase the risk of bleeding. Combining aspirin with other anticoagulant or antiplatelet medications, such as warfarin or clopidogrel, may potentiate the blood-thinning effects and increase the risk of bleeding complications.
   
5. Thyroid Medications: Ephedrine, a sympathomimetic amine, can potentially interact with thyroid medications, such as levothyroxine. Ephedrine may increase the release of thyroid hormones or interfere with their metabolism, leading to altered thyroid function and potential side effects.
   

Suggested Routine to naturally boost dopamine levels
​

1. Morning:

• Start the day with 30 minutes of moderate-intensity exercise, such as a brisk walk or a workout routine. This can help increase dopamine levels and promote overall well-being.
• Consume a balanced breakfast that includes foods rich in tyrosine, such as eggs, lean meats, or legumes. Include fruits or vegetables for added antioxidants.

​

1. Daytime:

• Throughout the day, practice stress management techniques whenever needed. Take short breaks to engage in deep breathing exercises, meditation, or mindfulness to reduce stress levels and support dopamine balance.
• Stay hydrated and consider replacing caffeinated beverages with herbal tea or water.

​

1. Afternoon:

• Take a break for creative activities or hobbies that bring you joy. This can include listening to music, painting, writing, or engaging in any other creative pursuits that stimulate dopamine release.

​

1. Evening:

• Allocate time for socializing with friends or loved ones. Plan activities like going for a walk together, having a meal, or engaging in meaningful conversations that promote positive social interactions and support dopamine levels.

1. Night:

• Before bedtime, create a calm and conducive environment for quality sleep. Establish a regular sleep schedule and aim for 7-9 hours of uninterrupted sleep. Avoid the use of caffeine or ephedrine in the evening, as they may interfere with sleep quality and dopamine regulation.

Dopamine Enhancing Dietary Overview
​

1. Proteins: Foods rich in proteins provide the necessary building blocks for dopamine synthesis. Include lean meats, poultry, fish, eggs, tofu, legumes, and dairy products in your diet.
   
2. Tyrosine-rich foods: Tyrosine is an amino acid involved in dopamine synthesis. Foods such as almonds, avocados, bananas, eggs, chicken, and turkey are good sources of tyrosine.
   
3. Leafy greens: Dark leafy greens like spinach, kale, and collard greens contain high levels of folate. Folate is important for neurotransmitter synthesis, including dopamine.
   
4. Fruits and vegetables: Berries, particularly blueberries, are rich in antioxidants and may have neuroprotective effects, promoting brain health. Other fruits and vegetables, such as oranges, tomatoes, and bell peppers, provide essential vitamins and minerals that support dopamine function.
   
5. Nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are rich in nutrients like magnesium, zinc, and omega-3 fatty acids, which are beneficial for brain health and neurotransmitter function.
   
6. Dark chocolate: Dark chocolate contains compounds like flavonoids and phenylethylamine (PEA), which may help enhance mood and support dopamine release. Choose dark chocolate with a high cocoa content (70% or higher) and consume in moderation.
   
7. Green tea: Green tea contains an amino acid called L-theanine, which has been shown to have a positive impact on dopamine levels and brain function. It can promote relaxation while enhancing alertness.
   
8. Turmeric: Turmeric contains curcumin, a compound known for its anti-inflammatory and antioxidant properties. It may help protect dopamine-producing neurons and support overall brain health.
   
9. Probiotic-rich foods: Emerging research suggests a link between gut health and dopamine production. Including fermented foods like yogurt, sauerkraut, kimchi, and kefir in your diet can support a healthy gut microbiome, which may indirectly influence dopamine levels.
   
10. Water: Staying hydrated is essential for optimal brain function, including neurotransmitter synthesis and release. Make sure to drink an adequate amount of water throughout the day.
    

Several vitamins play a role in the synthesis, regulation, and function of dopamine in the brain.
​

1. Vitamin B6 (Pyridoxine): Vitamin B6 is involved in the conversion of the amino acid L-tyrosine into dopamine. It is a co-factor for the enzyme aromatic L-amino acid decarboxylase, which helps convert L-tyrosine to L-DOPA, a precursor of dopamine.
   
2. Vitamin B9 (Folate): Folate is important for the synthesis and metabolism of neurotransmitters, including dopamine. It participates in the conversion of L-DOPA to dopamine through its role in one-carbon metabolism.
   
3. Vitamin B12 (Cobalamin): Vitamin B12 is involved in the formation of myelin sheaths, which protect nerve cells, including dopaminergic neurons. It also plays a role in the synthesis and maintenance of neurotransmitters, including dopamine.
   
4. Vitamin D: Vitamin D receptors are found in various brain regions, including those involved in dopamine synthesis and regulation. Vitamin D deficiency has been linked to altered dopamine signaling and neurotransmission.
   
5. Vitamin C: Vitamin C is an antioxidant that helps protect dopamine neurons from oxidative stress. It is involved in the biosynthesis of dopamine by acting as a cofactor for the enzyme dopamine β-hydroxylase.
   
6. Vitamin E: Vitamin E is an antioxidant that protects dopamine neurons from oxidative damage. It helps maintain the integrity and function of dopaminergic neurons.
   

Other Considerations: Enhance and Maintain dopamine levels
​

1. Regular exercise: Engaging in aerobic exercises like running, swimming, or cycling can stimulate dopamine release and promote overall brain health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
   
2. Get enough sleep: Quality sleep is essential for proper neurotransmitter function, including dopamine regulation. Aim for 7-9 hours of uninterrupted sleep each night to support optimal brain health.
   
3. Manage stress: Chronic stress can negatively impact dopamine levels. Explore stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.
   
4. Listen to music: Listening to music you love can induce pleasure and increase dopamine release. Choose music that uplifts your mood and makes you feel good.
   
5. Set and achieve goals: Accomplishing goals, both big and small, can activate the brain's reward pathways and boost dopamine levels. Break larger goals into smaller, achievable tasks to experience a sense of accomplishment along the way.
   
6. Practice mindfulness: Mindfulness exercises, such as meditation or mindful breathing, can help improve dopamine receptor sensitivity and enhance overall well-being.
   
7. Spend time in nature: Being in nature has been shown to have a positive impact on mood and overall brain health. Take walks in green spaces, go hiking, or simply spend time outdoors to potentially increase dopamine levels.
   
8. Socialize and connect: Engaging in meaningful social interactions, spending time with loved ones, and nurturing relationships can stimulate dopamine release and promote feelings of happiness and well-being.
   
9. Seek pleasurable experiences: Engage in activities that bring you joy and pleasure, whether it's playing a musical instrument, dancing, painting, or engaging in hobbies you are passionate about. Enjoying pleasurable experiences can enhance dopamine release.
   
10. Limit excessive dopamine-depleting behaviors: Certain behaviors like excessive consumption of alcohol, drug use, and excessive gambling can deplete dopamine levels over time. Moderation and balance are key.
    

Combating Weight Loss (If Needed)
While there are numerous meal replacement brands available worldwide, here are 10 well-known and popular brands that offer carb-intensive meal replacement options:
​

1. Soylent: Soylent offers a range of meal replacement products, including their original formula, which provides a balanced mix of carbohydrates, proteins, and fats.
   
2. Huel: Huel offers complete meal replacements in powder form, with options that include a significant amount of carbohydrates, sourced from oats and other ingredients.
   
3. Ample: Ample provides meal replacement shakes made from real food ingredients, including carbohydrates from sources like oats, sweet potato, and tapioca.
   
4. Garden of Life: Garden of Life offers meal replacement powders and shakes that are rich in carbohydrates, often derived from organic whole food sources like oats, quinoa, and fruits.
   
5. Orgain: Orgain produces organic meal replacement shakes that contain carbohydrates from ingredients such as brown rice, fruits, and vegetables.
   
6. Kate Farms: Kate Farms offers plant-based meal replacement shakes that provide a balance of macronutrients, including carbohydrates from organic pea protein and brown rice.
   
7. Vega: Vega offers a range of plant-based meal replacement shakes and powders that contain carbohydrates from sources like organic sprouted brown rice and organic quinoa.
   
8. Ensure: Ensure is a well-known brand that offers meal replacement shakes designed for nutrition and energy, with carbohydrate-rich options available.
   
9. SlimFast: SlimFast offers a variety of meal replacement shakes and bars, including carb-conscious options that provide a controlled amount of carbohydrates for those watching their carb intake.
   
10. Atkins: While primarily known for their low-carb products, Atkins also offers meal replacement shakes and bars with a focus on controlled carbohydrate intake.
    

Hi all,
I am starting my supplement journey. Am I on the right track going with Usana Healthpak?

I cannot recall ever seeing a discussion/study about this.
Piperine/Bioperine is an extract from black pepper that inhibits specific enzymes, CYP450 CYP2C9 which causes certain vitamins and minerals to be more thoroughly absorbed by the GI before they can be "taken apart" by overly aggressive toxin clearing mechanisms of the body.
This works great for some supplements, coq10 iron and several others but actually works against others and some drugs that rely on those enzymes to be metabolized.
I have no idea what category B3/Niacin/NNMN falls into with piperine.
Grain of salt as this is a manfacturer explainer but there are plenty of independent scientific studies to confirm what they claim:

• https://bioperine.com/mechanismsofactions/

also https://www.mdpi.com/2076-3417/9/20/4270/htm

Table 8.1 Compounds with documented bioavailability enhancement upon piperine co-administration Barbiturates Resveratrol Pyrazinamide Thiophylline Beta-carotene Propranolol Rifampicin Vitamin B-6 Coenzyme Q10 Nalorphine Selenium Phyllanthin Curcumin 

on the other hand, here is a warning how it hurts some other drugs
"piperine could be a potent inhibitor of cytochrome P450 metabolism of warfarin in vivo and, contrary to the expectation, may reduce the plasma concentration and anticoagulation of warfarin"

What's ciprofloxacin ?
Ciprofloxacin is a fluoroquinolone (flor-o-kwin-o-lone) antibiotic, it is used to treat unique kinds of bacterial infections. It's also used to treat humans who have been uncovered to anthrax or certain varieties of plague. Ciprofloxacin extended-launch is most effective accredited to be used in adults.
Fluoroquinolone antibiotics can motive severe or disabling facet consequences that might not be reversible.
Ciprofloxacin ought to be used only for infections that can not be treated with a more secure antibiotic.
Warnings
Ciprofloxacin can cause serious aspect results, which includes tendon troubles, nerve damage, extreme temper or conduct modifications, or low blood sugar.
Prevent the use of ciprofloxacin and phone your medical doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning ache, confusion, agitation, paranoia, problems with reminiscence or awareness, thoughts of suicide, or sudden pain or motion problems in any of your joints.
In uncommon instances, ciprofloxacin may additionally reason damage in your aorta, that could cause dangerous bleeding or dying. Get emergency medical help if you have intense and steady pain on your chest, belly, or lower back.
You may no longer be able to use this medicinal drug if you have a muscle ailment. Tell your medical doctor if you have a history of myasthenia gravis.
Earlier than taking this remedy
You must not use ciprofloxacin if you are allergic to it, or if:
You also take tizanidine; or
You are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may also motive swelling or tearing of a tendon (the fiber that connects bones to muscle tissues within the frame), specially in the achilles' tendon of the heel. This will occur during treatment or several months when you stop taking ciprofloxacin. Tendon problems can be much more likely in youngsters and older adults, or folks that use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, inform your medical doctor when you have ever had:
Arthritis or problems with your tendons, bones or joints (specially in children);
Diabetes, low blood sugar;
Nerve troubles;
An aneurysm or blood flow problems;
Coronary heart problems, or a coronary heart attack;
Muscle weak point, myasthenia gravis;
Liver or kidney disorder;
A seizure, head injury, or brain tumor;
Problem swallowing tablets;
Lengthy qt syndrome (in you or a family member); or
Low stages of potassium in your blood (hypokalemia).
Do not deliver this remedy to a child without clinical recommendation.
It isn't always known whether or not this medicine will harm an unborn child. Inform your health practitioner in case you are pregnant.
You must now not breastfeed even as taking ciprofloxacin and for 2 days after your ultimate dose. Ask your physician approximately breastfeeding if you take this remedy for anthrax exposure.
How should i take ciprofloxacin?
Take ciprofloxacin exactly as prescribed by way of your physician. Follow all instructions on your prescription label and study all medicine publications or coaching sheets.
Take ciprofloxacin on the same time every day, without or with food.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe furnished, or use a medicinal drug dose-measuring device (not a kitchen spoon). Do not provide ciprofloxacin oral suspension thru a feeding tube.
Swallow the prolonged-launch pill entire and do no longer weigh down, chew, or wreck it.
Drink masses of drinks even as you are taking this medicine.
Use ciprofloxacin for the full prescribed duration of time, even in case your signs and symptoms speedy improve. Skipping doses can growth your threat of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection which includes the flu or a commonplace cold.
Do now not share this remedy with any other person.
Store at room temperature away from moisture and heat. Do now not permit the liquid remedy to freeze. Throw away any unused liquid after 14 days.
What to avoid
Do now not take ciprofloxacin with dairy products which include milk or yogurt, or with calcium-fortified juice. You could consume or drink those merchandise along with your food, however do not use them by myself while taking this medicinal drug.
Antibiotic drugs can reason diarrhea, which can be a sign of a new infection. When you have diarrhea that is watery or bloody, call your health practitioner before the usage of anti-diarrhea medicine.
Ciprofloxacin may want to make you sunburn extra without difficulty. Keep away from sunlight or tanning beds. Put on shielding apparel and use sunscreen (spf 30 or better) while you are exterior. Inform your physician when you have severe burning, redness, itching, rash, or swelling after being inside the solar.
Keep away from using or unsafe interest till you know how ciprofloxacin will have an effect on you. Your reactions may be impaired.
Ciprofloxacin facet outcomes
Get emergency clinical help when you have signs of an hypersensitive reaction to ciprofloxacin (hives, difficult respiratory, swelling to your face or throat) or a excessive skin response (fever, sore throat, burning to your eyes, skin pain, red or crimson pores and skin rash that spreads and reasons blistering and peeling).
Ciprofloxacin can motive severe aspect results, which includes tendon troubles, harm for your nerves (which may be permanent), serious mood or conduct adjustments (after simply one dose), or low blood sugar (that can cause coma).
Stop taking this remedy and make contact with your health practitioner at once if you have:
Low blood sugar - headache, starvation, irritability, dizziness, nausea, rapid heart charge, or feeling shaky;
Nerve damage signs and symptoms - numbness, tingling, burning pain on your fingers, hands, legs, or ft:
Extreme temper or conduct adjustments - anxiousness, confusion, agitation, paranoia, hallucinations, reminiscence troubles, problem concentrating, thoughts of suicide; or
Symptoms of tendon rupture - surprising ache, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive hospital therapy or commands).
In uncommon instances, ciprofloxacin may additionally purpose damage for your aorta, the main blood artery of the frame. This will result in dangerous bleeding or demise. Get emergency scientific help if you have excessive and constant pain on your chest, belly, or returned.
Additionally, prevent using this medication and speak to your health practitioner immediately when you have:
Severe belly ache, diarrhea this is watery or bloody;
Rapid or pounding heartbeats, fluttering for your chest, shortness of breath, and unexpected dizziness (like you would possibly pass out);
Any skin rash, regardless of how mild;
Muscle weak spot, respiration issues;
Little or no urination;
Jaundice (yellowing of the pores and skin or eyes); or
Multiplied pressure within the skull - extreme complications, ringing on your ears, dizziness, nausea, imaginative and prescient troubles, ache at the back of your eyes.
Commonplace ciprofloxacin facet consequences may include:
Nausea, vomiting, diarrhea, stomach ache;
Headache; or
Extraordinary liver characteristic tests.
Remedies
Bladder infection
Ciprofloxacin
Print
Shop
Ciprofloxacin
Widely wide-spread name: ciprofloxacin (oral) [ SIP-roe-FLOX-a-sin ]
Brand names: cipro, proquin xr
Drug elegance: quinolones
Medically reviewed through kaci durbin, md. Closing updated on sep 30, 2021.
Makes use of
Warnings
Earlier than taking
Aspect consequences
Interactions
Dosage
Faq
What's ciprofloxacin?
Ciprofloxacin is a fluoroquinolone (flor-o-kwin-o-lone) antibiotic, it's far used to deal with one-of-a-kind varieties of bacterial infections. It's also used to treat humans who've been exposed to anthrax or positive varieties of plague. Ciprofloxacin prolonged-launch is simplest permitted to be used in adults.
Fluoroquinolone antibiotics can reason critical or disabling side outcomes that might not be reversible.
Ciprofloxacin ought to be used only for infections that can not be dealt with with a more secure antibiotic.
Warnings
Ciprofloxacin can purpose critical facet consequences, which includes tendon issues, nerve damage, serious temper or behavior changes, or low blood sugar.
Stop the usage of ciprofloxacin and get in touch with your physician at once if you have: headache, starvation, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, troubles with memory or attention, thoughts of suicide, or surprising pain or motion troubles in any of your joints.
In uncommon instances, ciprofloxacin may additionally reason damage on your aorta, that may result in dangerous bleeding or loss of life. Get emergency medical help when you have severe and steady pain on your chest, stomach, or again.
You can now not be able to use this remedy when you have a muscle disorder. Inform your doctor when you have a history of myasthenia gravis.
Earlier than taking this medication
You have to no longer use ciprofloxacin in case you are allergic to it, or if:
You furthermore mght take tizanidine; or
You're allergic to different fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may also reason swelling or tearing of a tendon (the fiber that connects bones to muscle tissues inside the frame), particularly within the achilles' tendon of the heel. This will manifest in the course of remedy or numerous months after you prevent taking ciprofloxacin. Tendon problems can be more likely in youngsters and older adults, or people who use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, tell your health practitioner if you have ever had:
Arthritis or problems with your tendons, bones or joints (specifically in youngsters);
Diabetes, low blood sugar;
Nerve troubles;
An aneurysm or blood circulate problems;
Heart troubles, or a heart assault;
Muscle weak point, myasthenia gravis;
Liver or kidney ailment;
A seizure, head harm, or brain tumor;
Problem swallowing capsules;
Lengthy qt syndrome (in you or a member of the family); or
Low ranges of potassium in your blood (hypokalemia).
Do now not deliver this remedy to a baby with out medical advice.
It is not regarded whether this medicinal drug will harm an unborn baby. Tell your medical doctor in case you are pregnant.
You have to not breastfeed at the same time as taking ciprofloxacin and for 2 days after your final dose. Ask your physician approximately breastfeeding if you take this medicinal drug for anthrax publicity.
How need to i take ciprofloxacin?
Take ciprofloxacin precisely as prescribed through your health practitioner. Comply with all guidelines for your prescription label and examine all medicinal drug courses or education sheets.
Take ciprofloxacin at the equal time every day, without or with meals.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe furnished, or use a medication dose-measuring device (no longer a kitchen spoon). Do not deliver ciprofloxacin oral suspension through a feeding tube.
Swallow the prolonged-release pill entire and do no longer crush, chunk, or break it.
Drink plenty of beverages while you're taking this medication.
Use ciprofloxacin for the whole prescribed length of time, even in case your signs and symptoms speedy improve. Skipping doses can boom your chance of contamination this is immune to medicine. Ciprofloxacin will not deal with a viral infection together with the flu or a commonplace cold.
Do not percentage this remedy with some other individual.
Store at room temperature far from moisture and heat. Do now not permit the liquid medicinal drug to freeze. Throw away any unused liquid after 14 days.
Exact ciprofloxacin dosage records
What happens if i leave out a dose?
If you take regular drugs or oral suspension: take the drugs as soon as you could, however bypass the ignored dose if your subsequent dose is due in less than 6 hours.
If you take extended-launch capsules: take the medication as quickly as you can, but skip the missed dose in case your next dose is due in much less than 8 hours.
Do no longer take doses at one time.
What occurs if i overdose?
Are looking for emergency medical interest or name the poison assist line at 1-800-222-1222.
What to keep away from
Do now not take ciprofloxacin with dairy merchandise inclusive of milk or yogurt, or with calcium-fortified juice. You can devour or drink these products together with your meals, however do no longer use them by myself when taking this medicine.
Antibiotic drugs can cause diarrhea, which may be a sign of a new contamination. When you have diarrhea that is watery or bloody, call your physician earlier than the usage of anti-diarrhea medicinal drug.
Ciprofloxacin could make you sunburn greater easily. Keep away from daylight or tanning beds. Put on protective apparel and use sunscreen (spf 30 or better) while you are outside. Inform your health practitioner when you have excessive burning, redness, itching, rash, or swelling after being in the solar.
Keep away from using or hazardous interest until you understand how ciprofloxacin will affect you. Your reactions could be impaired.
Ciprofloxacin aspect effects
Get emergency medical help when you have symptoms of an hypersensitive reaction to ciprofloxacin (hives, tough respiration, swelling for your face or throat) or a extreme skin response (fever, sore throat, burning on your eyes, pores and skin ache, pink or crimson pores and skin rash that spreads and causes blistering and peeling).
Ciprofloxacin can cause serious facet outcomes, inclusive of tendon troubles, damage for your nerves (which can be everlasting), severe mood or conduct adjustments (after just one dose), or low blood sugar (that may result in coma).
Stop taking this medication and call your physician immediately if you have:
Low blood sugar - headache, starvation, irritability, dizziness, nausea, speedy heart charge, or feeling shaky;
Nerve damage signs and symptoms - numbness, tingling, burning pain to your arms, palms, legs, or ft:
Serious temper or behavior modifications - anxiousness, confusion, agitation, paranoia, hallucinations, memory issues, problem concentrating, mind of suicide; or
Signs of tendon rupture - surprising pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (relaxation the joint till you receive medical care or instructions).
In rare instances, ciprofloxacin may additionally purpose harm on your aorta, the principle blood artery of the body. This will lead to risky bleeding or death. Get emergency clinical help if you have severe and constant ache to your chest, belly, or returned.
Additionally, prevent the usage of this medicine and get in touch with your physician right away when you have:
Intense stomach ache, diarrhea this is watery or bloody;
Speedy or pounding heartbeats, fluttering to your chest, shortness of breath, and sudden dizziness (like you would possibly skip out);
Any pores and skin rash, regardless of how moderate;
Muscle weak point, respiratory troubles;
Little or no urination;
Jaundice (yellowing of the pores and skin or eyes); or
Expanded stress in the cranium - extreme headaches, ringing to your ears, dizziness, nausea, imaginative and prescient troubles, ache behind your eyes.
Not unusual ciprofloxacin facet effects may additionally include:
Nausea, vomiting, diarrhea, belly pain;
Headache; or
Strange liver function checks.
This isn't a entire list of side outcomes and others may additionally occur. Name your doctor for medical advice about aspect outcomes. You could document side outcomes to fda at 1-800-fda-1088.
Ciprofloxacin side outcomes (more detail)
What other tablets will affect ciprofloxacin?
A few drug treatments can make ciprofloxacin a lot much less effective when taken at the identical time. If you take any of the subsequent medicines, take your ciprofloxacin dose 2 hours earlier than or 6 hours after you take the opposite medicinal drug.
The ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (along with maalox, milk of magnesia, mylanta, pepcid entire, rolaids, tums, and others);
Didanosine (videx) powder or chewable tablets;
Diet or mineral supplements that incorporate calcium, iron, magnesium, or zinc.
Tell your health practitioner about all your different drugs, particularly:
Clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
A blood thinner (warfarin, coumadin, jantoven);
Heart remedy or a diuretic or "water pill";
Oral diabetes medicinal drug;
Merchandise that comprise caffeine;
Remedy to treat melancholy or mental infection;
Steroid remedy (such as prednisone); o
Nsaids (nonsteroidal anti inflammatory tablets) - aspirin, ibuprofen (advil, motrin), naproxen (aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;
https://www.arshinepharma.com/info/uses-side-effects-and-precautions-for-taking-71254389.html

TL;DR: I am already using these supplements/tooth paste, so why not make a broscience study out of it?
Disclaimer: According to this sub's rules, "Broscience is accepted as it can lead to new theories and discoveries, but it must be clearly stated it is broscience or 'feel'."
The recent thread about vit K2 rebuilding tooth and my study into this very same topic, not to mention that I am already taking vit K2 for other reasons made me think, why not make this a study? Specially if I invite you to participate thus we may have a better, wider, more acceptable result.
I do believe that vit K2 supplementation can help to strengthen your teeth and fill up smaller holes, lowering sensitiveness. So you could judge me that I already have a positive bias. (based on my studies) Can it grow enamel? As long as my teeth get stronger and less sensitive, I don't particularly care which part of the tooth gets regrown, but the answer is probably no. We will find out, no matter how the Big Tooth industry doesn't want you to know. :)
A few links before we start, original discussion:
https://old.reddit.com/Supplements/comments/uezzd7/vitamin_k2_rebuilt_my_tooth_enamel_what/
Benefits of vit K2 regarding tooth:
https://www.metropolitandentalcarenyc.com/blog/vitamin-k2
https://www.ericdavisdental.com/faqs-and-blog/blog/vitamin-k2-and-its-benefits-for-teeth/
The design of the study. I am going to use 2 different approaches. I know, I know, it would be better to use them separately, but time is money and again, I am already using these (sup, paste).
I may take before pictures but I don't have holes just generally worn teeth, so pictures may not show much, if anything. But I urge you if you have holes and you decide to participate to take some.
The goal of the study is to make our teeth stronger and less sensitive using fairly cheap and (almost) natural resources. Some tooth paste can be natural, but most can't.
So here is how I am doing it:

1. I upped my vit K2 (both mk4 and mk7) intake and spread it out during the day, because mk4's half life is only 1-2 hours. 1 pill is 100 mcg mk4 and 50 mcg mk7. I take 2 pills twice a day. There is no upper (toxic) limit to vit K2 and one can buy megadoses if one desire so, like 5 mg or 45 mg in one pill. I think that is an overkill though. If you take Warfarin or similar medication, just forget about this idea. Vit K2 is fat solluble, so take it with food.
   
2. I am using the Italian made Biorepair tooth paste that itself lowers sensitivity and supplies minerals to the teeth. One special note how I use it. Since the time the paste interacts with your teeth is important (the longer the better) just using it to wash your teeth then rinse not gonna make it. So after washing my teeth I don't rinse, just spit it out and I also scrap my tongue to take most of it away, but this still leaves plenty around my teeth. Also during the day I may use it more often and leave it on to increase the time it can help remineralization. So about 4-5 times a day.
   

Now a note on tooth paste. In most of the word tooth paste is cosmetic, but in the US it falls under FDA regulation. Because of this, most of the special useful toothpastes are not in the US market, but can be bought online (Amazon). They are a bit pricey, but so is dental work. Remember prevention is always cheaper then treatment.
So here are a couple of candidates that may help your tooth remineralization, mentioned in the linked thread:

• Biorepair (Italy)
• Sensodyne with Novamin (Canada, East Europe)
• Boka with nano-Hydroxyapatite
• Apagard Premio (Japan)
• Orarestore Pro-Mineralizer by Oral Health

I think all of these are fluoride free.* I don't care about the whitening effect, that is not part of this study. Cost is $9-18 per tube, Apagard being the most expensive. Once I run out of Biorepair, I may switch to Boka or Apagard, because they use different ingredients
I intend to post results after 4-6 weeks. I have already been using Biorepair with positive effects (sensitivity), I just extended its use for the time of this study. For vit K2 I use the Microingredients brand, about $5 per month.
So I invite you to participate or if you have already been using any of these tooth paste, maybe add vit K2 to see if it helps even more.
See you in shall we say 5 weeks?
*People keep asking about this feature. It is not like I purposefully chose fluoride free pastes, they just all happen to be, I figured I would mention it, because some people care. Also, it is good they don't have it, thus all the ingredients are tested on their own, because we already know fluoride works, up to a point.
Update #1 (after a week): I definitely think tooth sensitivity is down. I ordered Apagard, and I am using both tooth paste 2-2 times a day. This may dilute the result even more introducing more variables, but they have different ingredients and I thought why not give a chance? I had to cut back on vit K2, I think the calcium movement was causing rigidity/sensitivity in my joints. Will increase it again slowly.
I will have another update in 10 days and a brand new post at the end of the month, for those who put reminders in this thread.
Update #2 (after 19 days): Not much change, same as the first update. I have one tooth that is really worn and I doubt that can be rebuilt but as long as it is not sensitive or the work on it can be pushed back by months I consider it a win. Another tooth has a little cavity channel parallel with the gumline. (hard brushing) I am hoping that can get filled, but probably would take 2-3 months. I can check it with my nail, maybe will try to take a picture of it. So far using my phone it doesn't really show up good and I am lazy a bit. The next update will be a separate post.
Update #3 after a month: Teeth are less sensitive. I can't tell if the enamel got stronger though. Probably it needs more time. It will be hard to measure anyway. I think a treatment like this twice a year for 1-2 months would be prudent.
The final update:
https://old.reddit.com/Supplements/comments/ww75s4/update_on_the_tooth_rebuilding_broscience_self/?

Clerking the Surgical Patient
Well, it’s finally happened. You're on your first surgical on-call. You’re alone in SAU; the only point of call for every surgical nurse in the hospital. Probably the region. You’ve got someone in room one with belly pain, someone in room 2 with a wound issue, and a crying medical student in room 3. Your registrar has gone off to polish his consultant’s car and told you in no uncertain terms to have the patients clerked and ‘sorted’ before he gets back otherwise ‘the bosses won’t be happy man, the bosses won’t be happy’.
Only thing – you think back to your surgical rotation at med school and it’s a blur of booze and fried chicken.
Here’s perhaps a helpful guide.
Surgical patients are deceptively simple. I see posts every now and then about surgeons using the CT scanner to diagnose everything, and while it’s got its basis in truth, there’s a lot more to it. Surgical patients tend to present with a set of similar symptoms for most conditions (eg. Belly pain, diarrhoea and vomiting) and your skill is identifying relevant bits in the history to guide you. You’ll likely need imaging, but knowing what you’re looking for – and why – makes all the difference.
While they may be simple, they’re usually very sick and can become very unwell very quickly. They will require careful resuscitation and a definitive management plan put in place.
Oftentime, there are multiple unwell patients and your consultants, registrars and SHOs won’t be around to help you. Whatever your feelings towards surgery or surgical doctors, you want to be the foundation doctors who can make a sensible management plan that isn’t just ‘Senior review’. You want to be a doctor and provide good care for your patients.
Step 1 – Introduce yourself.
‘Good evening Mr X. My name is Dr X, I’m one of the surgical team’
Your name is ‘Dr XX’ or “MMs X’.
I can’t get on board with this loss of professional titles. You worked for it, it’s your name now, own it. I make sure to introduce my juniors as Dr XX when we’re seeing a patient together.
Step 2 – Identify the presenting complaint
Seems obvious but in surgery things tend to be a little more clear cut than in medicine. Most surgical patients present with pain, or some kind of luminal symptom (diarrhoea / bleeding PR). Even then, it’s unusual for the latter not to be conflated with some kind of pain, especially in the acute take.
Beware extraneous detail. This is a hard skill. I’m not suggesting you try to reduce every symptom to a one line explanation, but there’s a subtle art to taking the relevant bits of history. Now, to be fair – my own methods here might seem a little too simplified to some. But it allows me to rapidly triage, assess and manage patients on my take and I’m good at my job.
For example – Mr Bells is a 29 year old male who has right iliac fossa pain and diarrhoea. He gives you a rambling history that takes five minutes to get through and you’re tasked with writing it down and trying to pick the pertinent points.
An unhelpful clerking: ‘Reports 27 hours of abdominal pain. Initially central throughout the day yesterday; patient moved from living room to bedroom and approximately one hour later, pain moved to RIF. Pain felt like it wasn’t ‘settling’ in right iliac fossa for another few hours. Complains of loose stool since yesterday morning; was unsure if needed to go to bathroom yesterday afternoon but had loose stool. Felt slightly more solid in the evening but the motion after this was loose. Describes some slightly liquid stool but no clear evidence of mucus – cannot be sure. No frank blood.’
A helpful clerking ‘1/7 history migratory RIF pain associated with loose stool (no blood/mucous)’
This is an art and you’ll realise that information is necessary and what isn’t as you present to other doctors and consultants.
Important associated symptoms
Diarrhoea - how often? Is it true diarrhoea? Any blood? And mucous? Crucially, *does it predate this acute episode and by how long?*
Vomiting - any blood? How many times? What’s coming up? (Food / bile) have you been having forceful vomiting for a while and now present with excruciating upper abdo pain? (Think Oesophageal rupture)
Weight loss - how much? Over how long? Intentional (and if so, realistic? I'm still scared about a four stone weight loss over 6 months, even if you've been dieting).
Change in bowel habit - generally anything over the last six months to a year is significant; anything older than that is unlikely to be associated to this acute presentation. What I mean by that - the old man who presents with a 6 month history of worsening constipation and weight loss is slightly more worrying than the old guy who’s been having loose stool for his entire life.
Women - any PV bleeding? When was your last period? Any PV discharge? (You May have to prod them on this; understandably it’s an embarrassing topic). What colour is the discharge? Is it new? Does it smell? Any new partners recently?
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Step 3 – Relevant past medical and surgical history
Not really much to add here – obviously big systemic issues such as diabetes, ischaemic heart disease need to be right at the top. Something very important to note – have they had previous surgery in their belly? If so, please make a note and make it clear – working up a RIF pain who’s had a right hemi for Crohn’s makes it suddenly a lot less likely to be appendicitis, for example.
Step 4 – Drug history
What are they taking? Make sure you have their meds and prescribe them in a timely fashion. Yes, the job sucks but it’s yours for the year. Things you need to make sure you sort immediately – PD meds, Diabetes meds.
Are they taking blood thinners? Vitally important – please find out what they are taking (Apixaban, Rivaroxaban and Edoxaban all have different durations of action) and when they last took it. As a general rule please hold any anticoagulants until reviewed by a senior. Make sure that the patient doesn’t take them either!
Alcohol and smoking – both relevant and important to know. Smoking actively gives you crappy wound healing.
Step 5 – Social history This can be brief in younger patients, but for elderly patients there are some things you need to ask. We ask these questions because it gives us a rough metric for their general fitness pre-illness. Using this, we can try to predict how well they’ll do after the immense trauma that is an operation. Here’re some useful questions. Who’s at home with you? Are you able to get about the house by yourself? Do you cook and clean for yourself? Are you able to climb a flight of stairs? If not, what stops you? – We ask this as it’s a rough guide for physical fitness. Patients are sometimes stopped by pain, but we’re really worried about whether they’re stopped by breathlessness – it’s a poor indicator for the physical fitness needed to get through a surgery. Do you have any carers? How far could you walk without getting out of breath?
When you present, you don’t need to include all of these questions individually. For example – ‘Mr Jameson is a 78 year old male who lives alone. He is independent in ADLs and has an unlimited exercise tolerance’ gets all the information to me.
Step 6 – Examination
Here we go. It’s time. You’ve gotta use those magic surgeon hands baby. One day, your humble hands will be the ‘could you just have a feel of his belly before we send him home…’ hands. One day, those hands will be in latex gloves, holding a retractor in theatre. It’s time.
So obviously there’s more to it than what’s written down here, but hopefully this will give you the basics.
Palpate the abdomen over the 9 subdivisions. You’re looking for tenderness, guarding (involuntary tensing of the abdominal muscles, secondary to an underlying pathology), and possibly peritonism.
But what does it all mean?!
Briefly – organs can either be intraperitoneal or retroperitoneal*. Intraperitoneal organs live within the peritoneal cavity, and are surrounded by a double layer of peritoneum. They are usually somewhat mobile, as they have some flexibility due to their peritoneal covering. I won’t go into the exact anatomy here (maybe a different post…?) but essentially – if an intraperitoneal organ becomes inflamed, then you’re going to get pain that is at first ill-defined and referred to the general area supplied by that portion of the gut.
What I mean by this – your appendix is part of the midgut. When you have appendicitis, you won’t be peritonitic in your RIF immediately. As the appendix becomes inflamed, you have visceral pain referred to your umbilicus, as all midgut pain is referred to the umbilicus / middle area. By the same token, foregut pain is referred to the epigastric region and hindgut pain is referred to your suprapubic region.
After a while, the inflammation will progress to such a point that the peritoneum surrounding the organ (the visceral peritoneum) will become inflamed. This means that should the overlying parietal peritoneum come into contact with an inflamed organ, you’ll get peritoneal pain, and an involuntary tensing of the abdominal muscles over that area. This is what’s known as being ‘peritonitic’.
Therefore, your young gentleman with appendicitis will initially have vague, visceral pain referred to the midgut region – the umbilicus. As the organ becomes more diseased and inflamed, the peritoneum around the organ will become inflamed; and this will lead to the pain associated with the right iliac fossa as the parietal peritoneum overlying it will become irritated.
This also explains why pyelonephritis, for example, cannot make you peritonitic – the kidneys are retroperitoneal. Same goes for a AAA – you will get vague belly pain radiating to the back, but you won’t be peritonitic.
So what’s the difference between locally peritonitic and generally peritonitic? Well, let’s use an example. Mr McCafe has appendicitis. He presents to ED, and the examining doctors notes local peritonism in the right iliac fossa. This is localised because the inflammation is localised to one area. Unfortunately, before he can get to theatre, he becomes suddenly more unwell. Upon re-examining him, you note that he now has peritonism of his whole lower abdomen. This is because the appendix has perforated, and there is free pus irritating the intraperitoneal cavity of the lower abdomen and therefore, the organs within the lower abdomen. He still doesn’t make it to theatre, and this inflammation spreads throughout the entire abdominal cavity. Now, wherever you press on his belly, he’s peritonitic – he has generalised peritonism.
Be aware that patients often tense their abdomen in response to the thought of pain. This is called ‘Voluntary’ guarding. The trick is trying to distract them so you can elicit what is true guarding, versus voluntary guarding. One represents peritonism, and one may not – be careful! I often find talking to the patients about something or other, or distracting them some other way helps them relax and they stop tensing on purpose.
After examining the abdomen, make sure to examine their groin for herniae. This is especially true if you’re worried about bowel obstruction.
Complete the examination with a PR exam – this will give you a massive amount of information. There’s an argument I always see amongst juniors which is ‘well, the SPR will just do it again anyways…’ which is true, but you need to practice so that one day, when you’re any kind of SPR / GP / Consultant, you know what you’re feeling for.
Special tests

• Rovsing’s sign – palpation of the LIF will elicit RIF pain in a patient with appendicitis. The theory is that palpating the LIF will cause gas within the left colon to move back towards the right colon; this will distend the caecum and stretch the appendiceal orifice causing pain.
• Psoas sign – the patient is lain on their left hand side, while the right thigh is passively extended. Pain on this test indicates a retrocaecal appendix. Not massively useful if I’m honest.
• Sometimes, if you’re unsure, ask them to cough. That will reveal peritonism in a particular area. Asking them to jump up and down can do the same thing.

Nb. Retroperitoneal organs – Suprarenals, Aorta, Duodenum (2nd, 3rd, 4th parts), Pancreas, Ureters, Colon (Ascending and Descending), Kidneys, Esophagus, Rectum, Bladder
Step 7 – Investigations
Bloods – FBC, U&E, LFTs, Amylase, Lactate, Clotting and G&S. Order these for every patient and you won’t go awry.
A venous blood gas is excellent to establish a baseline for your patient and will give you their acid-base status and their lactate. These can be taken serially to assess whether your interventions are having the desired effect.
Urine dip & pregnancy test – mandatory.
Erect CXR – perforations of an intraabdominal viscus will cause a pneumoperitoneum (free air within the abdominal cavity). Beware – a normal CXR doesn’t rule out a perforation! 60-70% of perforations are seen on eCXR, leaving a whole 1/3rd of presentations that will not be adequately identified. Further, retroperitoneal perforations – eg duodenum – obviously will not show a pneumoperitoneum as the air would not enter the peritoneal cavity.
Therefore if you are convinced about a perforation and the eCXR is normal, it’s still sensible to proceed with cross sectional imaging.
Speaking of which…do I need a scan, and if so – what kind of scan?
So, we’ve got a few different imaging modalities to sink our teeth into. These all have different uses.

1. CXR – Use to look for lower lobe pneumoniae which can masquerade as abdo pain. Also used tp look for a pneumo. You will never regret getting one; do them as standard for every patient. They must be upright for 20 mins before the picture to ensure that air rises to the top.
2. AXR – Use this only if looking for symptoms of obstruction. You are looking for dilated loops of small bowel or large bowel. This is beyond the scope of this discussion, but we only use AXRs to look or obstructive symptoms. Don’t order them for anything else. a. Gastrografin – sometimes if we have made a diagnosis of adhesional small bowel obstruction, we can use an oral contrast medium to try to relieve the issue. Gastrografin has some properties which means that it can gently stimulate the bowel and try to relieve adhesional obstruction. As such, sometimes we try GG x rays – serial x rays looking for the passage of GG into the large bowel. If we see GG in the small bowel on AXR#1, and then in the large bowel on AXR#2, it means that the obstruction has resolved / is resolving.
3. USS abdo – Ultrasound is much better at picking up gallstones than CT. Use USS to look for the presence of stones, cholecystitis or to look for biliary tree abnormalities. a. Why not CT? Because gallstones are either cholesterol, pigment or both. These are not kidney stones which are made of mineral. CT is perfect for kidney stones because it shows up metallic elements – eg stones, bone etc. Gallstones aren’t usually metallic, unless they’ve been present for so long they’ve become calcified. b. Pelvic ultrasounds are excellent for looking at the ovaries and uterus.
4. CTAP – the donut of truth. Cheap, reproducible and not operator dependent. Gold standard for most surgical diagnoses – gallstones and gynae excepted. There is a concern about radiation risk; approximately 1/400 risk of cancer for women of child bearing age, 1/600 for dudes. These figures might be old; happy to be corrected. Obviously make sure they’re not pregnant beforehand. Get some practice with your reg trying to figure out which cases need a scan and which don’t; there’s no reason you cannot book scans if you feel them clinicially appropriate. a. CT Scans with contrast are the standard. b. CT without contrast is only used for looking for stones. Please do not book them for anything else – they’re difficult to interpret and don’t really help.

There are obviously more, but for your level this is probably enough.
Step 8 – Make a management plan!
Right – so you’ve taken a decent history, examined your patient and now it’s time for the dreaded management plan.
Your job in the management plan is to stabilise the patient, advance their treatment and prep them for definitive intervention. Sounds difficult? Not at all! Let’s go through bit by bit. Here’s a little framework.
Interventions

1. Analgesia
2. Abx
3. IVI
4. Ryles tube and oral intake
5. Imaging
6. Clots
7. Theatre

Sepsis
Sepsis kills. If in any doubt, activate the sepsis six.
GIVE – IV fluids, Oxygen (maintain sats >94%), Broad spectrum Abx (though if you’re sure it’s a GI pathology, then give them more targeted therapy).
TAKE – Urine output (Catheterise them), Bloods inc. cultures, a lactate (a baseline VBG is excellent).
Step 1 – Analgesia
The type of pain relief you give depends on how bad the patient’s pain is, whether they’re ambulant or not, and how sick they are.
Basic guidance – start off small and increase as needed. Paracetamol / Codeine / Morphine. I’m not thrilled about giving NSAIDs to GI patients as a whole; there are some conditions where it’s appropriate (gallbladder stuff / pancreatitis / abscesses). Happy to be corrected on this by cleverer people.
PO / IV Paracetamol – give to everyone.
Codeine – trial 15mg PO QDS if it looks like they can go home; move to 30mg or even 60mg. If they’re requiring 60mg of Codeine however, ask yourself – is this someone safe to be at home? The answer may well be yes, of course. But important to ask the question.

• Codeine slows the GI tract and we use it for reducing ileostomy output as well as analgesia. If you are concerned your patient may have constipation, please don’t use this.

Morphine – if you’re giving morphine to a patient, they probably need to be in hospital. That doesn’t mean that everyone who gets 10mg of PO Oramorph needs admission; that means that If you assess their pain properly and start off on the lower doses of other medications, you can avoid the morphine altogether. If their pain is only controlled with morphine, you need to be a little more concerned that there’s something serious going on.

• PO Morphine is good as a little ‘top up’, but its short acting and wears off quickly. Don’t be afraid of giving it regularly if needed; 15mg/2-4h isn’t an unreasonable regime.
• IV morphine may be needed if the pain is truly uncontrollable. Obviously this isn’t a long term solution; it’s likely the patient will require some kind of operative intervention.

PCA – This is for patients with a proven condition who will require ongoing, regular analgesia – eg. Pancreatitis. Rib fracture patients do well with this, because it allows them to inspire properly and avoid risks of atelectasis. Don’t start by yourself; discuss with a senior (though by all means add it to your plan!)
If they’re going home, what’s the least amount of analgesia you can give to help them at home? This is another reason why it’s good not to just start off with PO morphine; you need to know the minimum that works for them.
Step 2 - Antibiotics
Does your patient need an antibiotic? The answer feels like it should be ‘yes’, but let’s hold up for a second. Why are we giving antibiotics?
You’re trying to treat the very real threat that your patient has bacteria where it shouldn’t be. Obviously, perforations (Gastric, small bowel, large bowel) all require antibiotics.
But what about non-perforated GI tract inflammation? Well, we usually do treat these with antimicrobials, and the reason we do that is that inflammation causes the affected tissue to become oedematous, leaky and more friable. This can lead to bacterial translocation from an area where bacteria belongs (eg your small bowel) to an area where it doesn’t belong (ie. The sterile intraperitoneal cavity). If in doubt, give antibiotics**.
There are a couple of exceptions, however (lol of course).

1. Appendicits that’s been clinically diagnosed, and there’s doubt. Let’s say Mr Cakebox came into hospital with vaguely appendicitis-sounding symtpoms. He’s 25, fit and well, and you’re a little stuck as to whether to take him for an operation or not. Your consultant decides to let him cook for the next 12 hours to see which way he goes – will his pain and inflammation get worse, and therefore declare himself as a true appendicitis? Or will his symptoms improve and turn out to be a simple case of mild gastroenteritis? If you give him antibiotics on his admission, then you’re going to end up partially treating the appendicitis and mask future clinical examination. Therefore;
   1. a. Unclear history and decision for theatre NOT made = hold off Abx
   2. b. Unclear history but decision for theatre HAS BEEN made = give Abx
   3. c. Clear history and decision for theatre HAS BEEN MADE = give Abx
   4. d. Imaging-proven Appendicitis = give Abx.
2. Diverticulitis – there’s some debate as to whether Abx actually help with mild Diverticulitis. Err on the safe side; give whatever your senior wants. This is usually if they’re well enough to go home.
   1. a. If the patient is septic – give abx.
3. Pancreatitis. Pancreatitis is a sterile (at least in the beginning) process. While it will cause a systemic inflammatory response which will mimic the sepsis response, it Is not in itself a septic process. Remember – Sepsis is SIRS in the presence of an established infective focus.
   1. a. Your pancreatitic who is spiking temperatures of 38.4, is tachycardic and has a low blood pressure is exhibiting organ dysfunction in response to the inflammatory response to their pancreatitis. Antibiotics cannot help them.
   2. b. Your perforated diverticulitis who is tachycardic, pyrexial and hypotensive is exhibiting a septic response to an infective stimulus. They are septic because they have SIRS with an established infective focus.

The choice of antibiotics will of course depend upon your local formulary.
Step 3 – IV Fluids
This is a contentious issue and I don’t pretend to be an expert. I’ll say this; if the patient is complex in terms of CCF or renal failure etc – ask for senior advice before prescribing anything more than a litre or so yourself. We try to use physiologically balanced solutions – eg Hartmann’s. The idea is that it has a composition as close to normal plasma as possible. As a general rule, if you’re admitting someone and they’re nil by mouth, start them on IVI. Approximately 2.5-3L/day will suffice – that’s around 3x8h bags. If they’re septic or fluid deplete, this rate will need to be increased. I won’t go into how to correct various abnormalities here – there’s e-learning which can do it much better than me.
Bottom line – if they’re staying in, give them a 4-8/h bag of Hartmann’s. If they’re sick, put it up on the quicker side. If they’re not, and it’s just because you’re starving them before a senior review – 8h is fine.
If you’re worried about their fluid balance / they’re septic / they’re clearly not going anywhere because of how sick they are – place a catheter and get an accurate fluid balance going.
Step 4 – Oral intake
If in doubt, make them nil by mouth. Nil by mouth does not mean that they cannot take oral medications. If you think they might need a Ryles, they need a Ryles.
These are the three main rules you need to keep in mind. When you first start off, keep every patient you see nil by mouth. Worst case scenario? You’ve starved someone for a while before your reg gets to them. No harm done.
Vomiting patients are dangerous patients, because they can aspirate their GI contents and they’ll get an awful aspiration pneumonia. As such, anyone we suspect to be in obstruction, we put a Ryles tube into and leave it on free drainage (though if you put it in, please document how much comes out!). The Ryles will continually empty the stomach and should prevent them aspirating. People who are being sick due to another pathology – eg appendicitis or pancreatitis – don’t need a Ryles necessarily as they’re no hindrance of their GI motility (it may be sluggish due to their illness but that’s not really a need to put a Ryles in).
Even if your SPR comes in and yanks that tube out, you’ve done them no harm – as opposed to the harm that may come to them if they aspirate from a subacute obstruction.
Step 5 – Imaging
Do they need a scan and do they need it now? If they do, then certainly feel free to tee them up for it – ie. Have a request planned out, have the renal function ready and ensure they’re not pregnant. If you’re utterly sure – eg. A 65 year old male with raised inflammatory markers and new local RIF peritonism, ? appendicitis ? malignancy – go ahead and book. Back yourself. If it’s a truly wild scan, the Radiologist will (gently) ask you to reconsider your plan / differential / life.
If they’re well, can the imaging be done as an outpatient? Your ?biliary colic patient who feels much better now doesn’t have to wait 3 days for an inpatient scan – they can be discharged and scanned as an outpatient.
Review any x rays they've had. If they have not had an erect CXR, get them one! As we said, you can do very little harm. Get them an ECG. Worst case scenario - you waste a strip of paper and you get to read a normal ECG again. Best case scenario - you pick up some cardiac stuff that needs to be fixed before slice-time.
Step 6 - Clots
Blood clots suck. You don't want your patients to develop them. Unfortunately, the systemic inflammation that is present in septic patients, along with the prolonged periods of immobility that occur during / after an operation gives us the perfect breeding ground for a clot (damn you Virchow).
Every patient admitted to hospital requires thromboprophylaxis in some shape or form.
For a standard patient not taking any other anticoagulant medications and with no particular risk factors, Dalteparin 5,000units is a standard dose. Use your intranet / Pharmacist's knowledge to increase the dose if your patient is obese.
If your patient has a condition predisposing to clots - eg AF, or previous unprovoked clots - they're to be started on the treatment dose of Dalteparin 18,000units. This is also the case if they've got a metallic heart valve. This can be administered either in a single dose or a split dose. The benefit of a split dose is it means that the anticoagulant effect can be modulated depending on how much we want to stop our patient bleeding. I wouldn't worry about this bit yet.
If your patient is stable on a DOAC, I would move them to Dalteparin for the duration of their hospital stay.
If your patient is on Warfarin, then they will need their INR checked. Depending on their INR and the urgency of the surgical intervention, they will need their Warfarin reversing, and then commencement with Dalteparin.
When do I start anticoagulation? - Essentially whenever gives us the lowest risk of bleeding during surgery.
Young, fit and well patients
- It's 3pm. You've admitted a young, fit lad to SAU for a ?Appendicitis. Prescribe him Dalteparin from tomorrow on the off-chance that he goes to theatre tonight / needs surgery in the evening after a senior review.
- It's now 5pm; your plan from the reg is for a CT scan tomorrow. He can have today's 6pm dose of Dalteparin because he's not for a surgical intervention tonight.
Patients taking a DOAC at home
- Ask when they last took their Apixaban / Edoxaban / Rivaroxaban etc. Differnet DOACs have different effect times. Eg.
- Edoxaban requires a 24h period from the last dose.
- Apixaban requires a 48h period from the last dose (remember, Apixaban tends to be BD dosing).
- Rivaroxaban requires a 24h period from the last dose.
Do not prescribe Dalteparin while they still have the effects of the DOAC in their system (https://www.ncbi.nlm.nih.gov/books/NBK557590/)
Eg. Mr Cookbook took his Friday morning Apixaban which he is taking for AF. It is now Friday lunchtime. He is admitted with diverticulitis. Do not prescribe him a Friday evening dose of Dalteparin, and hold off further doses until he either has his surgery, or he is at a point where he can be safely moved onto Heparin. Be guided by your registrar. In my personal experience, I would commence prophylactic Dalteparin on Saturday evening in this patient, though i'm aware some would wait until Sunday afternoon.
Patients taking Warfarin
Mr Coaster is taking Warfarin for AF. He is admitted with severe cholecystitis. His INR is 3. When he is admitted, consider prescribing Vitamin K to reduce his INR to <2. Vitamin K will not make you clot. Following this, he can be commenced upon Heparin. This is because if the patient might need a surgical intervention, it's always better to have them on an anticoagulant you can control (ie Dalteprin), rather than one you are at the mercy of (Warfarin and the INR taking a little while to come down).
Timing of surgery with Dalteparin
General rule - hold prophylactic dalteparin 12h pre op. Most patients can therefore have Dalteparin the evening before their planned surgical intervention.
Therapeutic - 24h pre-op. This is usually achieved either by
- splitting the dose and holding just the evening dose on the day before surgery and the morning dose of the day of surgery (Eg. Monday AM PM, Tuesday (Operation day) AM PM)
-holding the evening dose from the day before the day before surgery (Eg. Monday PM, Tuesday PM, Wednesday (Operation Day) PM)
- Move the dosing to the morning. The issue with this is it tends to preclude decisions for theatre made during the day.
As you can see, it's slightly messy. Don't do anything before taking to your SPR.
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Step 7 – Theatre
You may be conviced that a patient requires theatre. Excellent! Surgery abounds. If you follow the previous 5 steps, you’ll realise you have prepped them adequately. You’ve given them pain relief, antibiotics and fluids. You’ve catheterised them and kept them nil by mouth. Their bloods including clotting is done. Your registrar will arrive, realise you’ve done it all and invite you to theatre to take out this guy’s appendix. Or, if you desperately hate theatre, they’ll buy you a coffee and hold your bleep for a while.
Hope this has been helpful.
Next step – common diagnoses!

limiting the use of heating processes that can damage the hairPossible causes of hair loss include androgenetic alopecia, pregnancy, and telogen effluvium.Androgenetic alopecia is another term for male or female pattern baldness. It is a very common cause of hair loss.Both male and female pattern baldness is genetic. Males tend to lose hair from the temples and crown of the head. In females, hair usually becomes thinner all over the head.Androgenetic alopecia is more likely to happen as a person ages but can start at any point after puberty. Many females who experience androgenetic alopecia develop it after going through the menopause. This means that hormones may have something to do with it.It is possible to treat this condition with minoxidil, a medication for hair growth.2. PregnancySome women may experience excessive hair loss shortly after giving birth. This is due to a decrease in estrogen levels. This type of hair loss is a temporary condition and usually resolves within a year or sooner.To help hair return to its normal condition, try:using a volumizing shampoo and conditionerusing products designed for fine hairavoiding intensive conditioners or conditioning shampoos as these can be too heavy for fine hairapplying conditioner to the ends of the hair, rather than the scalp, to avoid weighing hair down3. Telogen effluviumTelogen effluvium is a condition where the hair remains in the telogen (natural shedding) phase of the growth cycle. This causes more hair to fall out, sometimes in handfuls.Telogen effluvium is usually a temporary condition that resolves over time. It is advisable to see a doctor to find out the cause.Some possible causes include:severe stresssurgerychildbirthrapid weight lossthyroid problemscertain medicationsA doctor will need to treat any underlying causes of telogen effluvium.If a doctor suspects that specific medications are causing hair loss, they may change them.4. Anagen effluviumAnagen effluvium causes large amounts of hair to fall out rapidly during the anagen (growth) phase of the hair cycle.The condition may cause hair to fall out from the head, as well as from other parts of the body, including eyebrows and eyelashes.Causes of anagen effluvium include:chemotherapyradiationfungal infectionsautoimmune diseaseTreatment for this condition depends on the cause but can include a topical solution of minoxidil.If a person has anagen effluvium as a result of undergoing chemotherapy, cooling the scalp during the procedure may help. Hair will often grow back 3–6 months after stopping chemotherapy.5. Alopecia areataAlopecia areata is an autoimmune condition that causes hair to fall out suddenly. The immune system attacks hair follicles, along with other healthy parts of the body.Hair from the scalp, as well as eyebrows and eyelashes, may fall out in small chunks.If a person has this condition, they should see a doctor. A doctor may prescribe medication to help the hair grow back.6. Traction alopeciaTraction alopecia is hair loss due to pulling hair into tight hairstyles, which causes it to break and come loose. Hairstyles associated with this condition include:tight buns or ponytailsbraidscornrowsextensionsIf traction alopecia continues, a person may develop bald spots and thinning of the hair.In terms of self-care, avoiding tight hairstyles will usually prevent further damage.7. MedicationsCertain medications have side effects that can cause hair to fall out.Examples of such medications include:blood thinners, such as warfarinAccutane, to treat acneantidepressants, including Prozac and Zoloftbeta-blockerscholesterol-lowering drugs, such as LopidIf a person thinks hair loss may be due to a medication they are taking, they should consider seeing a doctor for an assessment. The doctor might be able to reduce the dosage or switch the person to a different medication.8. Nutritional deficienciesNutritional deficiencies can cause hair to fall out. Extreme diets that are too low in protein and certain vitamins, such as iron, can sometimes cause excessive hair shedding.A person should see a doctor for a blood test to check if they have a nutritional deficiency that could be causing their hair to fall out.9. Birth control pillsPeople may experience hair loss while using birth control pills. Others might experience hair loss several weeks or months after they stop taking them.If people are taking birth control pills, they can choose one that has a low androgen index. This may help to lower the risk of hair loss.Examples of birth control pills with a lower androgen index include:DesogenOrtho-CeptOrtho-CyclenOvral and Loestrin have a higher androgen index.Other forms of birth control that affect the hormones, such as implants and skin patches, may also cause hair loss.The American Hair Loss Association recommend that people who have an increased risk of genetic hair loss opt for a non-hormonal type of birth control.10. RingwormRingworm is a fungal infection that can cause hair loss. Ringworm on the scalp, or tinea capitis, can cause temporary bald areas on the head.Symptoms include:a small spot that gets bigger, causing scaly, bald patches of skinbrittle hair that breaks easilyitchy, red patches of skin in the affected areasoozing blisters on the scalpring-like patches, with a red outside and the inside of the circle matching the skin toneIf ringworm does not heal by itself, then a doctor may prescribe an antifungal medicine. Alternatively, they may prescribe an antibiotic, such as Griseofulvin.Self-careTo prevent hair loss, people may want to try:lifestyle changes to reduce stresseating a nutritious diet that includes proteins, fats, and certain vitamins and mineralsThe following may also help to stop further hair loss:using a lightweight shampoo and conditioner to avoid weighing down the hairavoiding tight hairstyleslimiting the ushaire of heating processes that can damage the hairhair
https://www.btasim.com/2022/01/causes-of-hair-loss\_01116965261.html

I go to a clinic that specializes in long Covid. These are some tips they've given me to help me through the recovery process. Maybe this'll help someone else who's suffering out there as well. Good luck.
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NUTRITION RECOMMENDATIONS for COVID Recovery
Daily Multi Vitamin with 1000 mg Vitamin C, 2000 U Vitamin D3, Magnesium 320 mg/day for women and 420 mg/d for men.
-Stay hydrated
-Anti-inflammatory diet/Mediterranean diet
-Anti-inflammatory lifestyle includes: anti-inflammatory diet, not smoking, limiting alcohol intake, exercise/activity, good quality sleep, reducing stress, managing weight
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DIET
Anti-inflammatory/Mediterranean Diet- Eat a diet high in fruits, vegetables, whole grains, nuts and seeds. Limit processed foods and simple carbohydrates like sugar and white flour. Eat smaller, more frequent meals
-Vegetables and Fruits: Aim for 7-10 servings per day. Eat the rainbow! A variety of colors will ensure you are getting the right micronutrients.
-Whole Grains: Opt for oats, quinoa, brown rice, barley, buckwheat, and whole grain breads/pasta/crackers.
-Healthy fats: olive oil, nuts and seeds, avocados, fatty fish (mackerel, sardines, salmon, herring). Avoid trans-fats often found in processed foods.
-Dairy: low-fat Greek or plain yogurt, cheese, and milk products from animals that were not fed antibiotics (look for words like “grass-fed”, “organic”, or “raised without antibiotics”).
-Eggs: Limit to one per day, or an average of 5-7 per week. Look for words like “pasture-raised” or “free-range”. These eggs have better nutrients than “cage-free” or “caged”.
-Spices: more spices, less salt. Use spices when cooking (turmeric, onions, garlic, ginger, and cinnamon) all have been associated with lowering levels of inflammation, as have lignans
(flaxseed, whole grains, berries), olive oil, fiber, nuts, and magnesium.
-Meat: Avoid red meat if possible, only eat it on special occasions. Substitute with fish, or lean meat. Again, look for key words that indicate it was minimally processed and without antibiotics. Buy local if possible. Limit meat to 3 oz three times per week.
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Cut down on sugar!
Do not exceed 25-35 grams of sugar per day.
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Artificial and natural sweeteners do not spike your blood sugar and have zero calories, BUT they have been associated with inflammation. Additionally, the taste of sweeteners is much sweeter than regular sugar and can contribute to addiction to the products. This is why diet soda has been associated with an increased risk of diseases like obesity, high blood pressure, high cholesterol, and diabetes. Choose your sweeteners carefully.
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Fruits and vegetables with natural sugars do not spike your blood sugar due to the fiber content when you eat them. Which is why it may be better to opt for a smoothie instead of a juice.
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Water- Drink to thirst! Carry around a water bottle to make it easier. Aim for at least eight 8 oz. glasses of water per day.
-Plain water
-Carbonated water
-Can add lemon juice
-Herbal teas
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What to avoid
-Foods that are high in unhealthy fats
-Foods that are high in sugar
-Alcohol/other depressants
-Smoking
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How to get started
-Keep track of what you are eating
-The Daily Dozen app is a great way to track if you are eating the basics every day.
-Smartphone apps: My Fitness Pal, My Plate, Lose It! All can track your daily intake of nutrients.
-Mediterranean Diet cookbooks, online recipes
-Anti-inflammatory Diet: online resources or book The Abascal Way by Kathy Abascal
-Dietician referral if desired
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"BRAIN" FOODS
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Polyphenols
-Organic compounds mostly found in plants
-Anti-oxidant and anti-inflammatory properties
-Support a healthy brain and cardiovascular system
-Found in berries, grapes, coffee, green tea, curcumin (turmeric), cocoa (at least 70%), nuts
Brain-Derived Neurotrophic Factor
-Associated with neurogenesis
-Blueberries, fish, turmeric
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Omega 3 Fatty Acids
-Fish, nuts, flaxseeds
-May have a role in oxidation and inflammation
-May promote cardiovascular health and cognition
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B vitamins
-Leafy greens, legumes, seafood, poultry, eggs, dairy
-Involved in the production of many neurotransmitters
-May promote nerve and brain health
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SUPPLEMENTS
We generally encourage people to get their vitamins and healthy fats through food (as studies consistently reflect that people do better with food-based whether it's Calcium or Fish oil).
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Dietary supplements
-Dietary supplements are NOT regulated by the FDA
-It is up to the manufacturer to ensure safety of the product
-Better to eat a well-balanced diet to obtain vitamins and minerals
-Some supplements may interact with prescription medications
-Talk to your doctor before starting a supplement
Supplements that have shown some promise in reducing severity in new COVID infections and are being further evaluated with studies:
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Vitamin D3
-Dose: 2000 IU per day in the early phases of COVID illness or until levels are normal, then multivitamin with 600-800 IU/day
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Vitamin C
-Dose: 1000 mg twice per day in the early phases of COVID illness then multivitamin
Zinc
-Higher doses of intranasal zinc have been used in treating severe COVID with unclear benefit
-Dose: 8 mg/day for women 11 mg/ day for men is the recommended daily allowance (RDA)
-Long-term zinc supplementation can cause copper deficiency with subsequent hematologic and potentially irreversible neurologic problems.
-Oral zinc can decrease the absorption of medications that bind with polyvalent cations.
-Because Zinc can have negative side effects, it is not recommended to take doses above the recommended daily allowance (RDA) listed above
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Magnesium
-May help with headaches, mood, sleep
-Dose: Start with 100-200mg in the evening
Maximum does 320 mg/day for women and 420 mg/d for men
-Monitor for loose stools
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Melatonin
-Can help restore normal sleep/wake cycle, studies ongoing about potential role in prevention and treatment of COVID-19.
-Dose: Start with 3-5mg and increase as needed up to 10 mg
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Supplements that have been used to manage similar symptoms in other medical conditions, but have not been specifically studied for COVID patients:
Probiotics
-Help with gut microbiome
-Many different formulations
-Choose one with several strains of bacteria and adequate colony forming units (CFU)
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B Vitamins
-May help with mood, nerve health, headache prevention
-Vitamin B2 (riboflavin) – 400mg daily (can make urine bright yellow)
-Vitamin B12 (cobalamin) – 1000 mcg daily
-B Complex multi-vitamin likely to cover these doses and have additional B vitamins
Omega 3 Fatty Acids (Fish Oil)
-Anti-inflammatory properties, reduce oxidative stress
-May help with cognition
-DHA (Docosahexaenoic acid) and EPA (Eicosapentaenoic acid)
-Dose: 1-2 g per day
*Please check with your Primary Care Doctor prior to starting this supplement if you are on Warfarin/Coumadin
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Curcumin
-Component of the spice herb turmeric
-Thought to have anti-inflammatory and antioxidant properties.
-Choose a supplement with piperine or bioperine
-Dose: 500 mg 1-2 times per day. Can go up to 500 mg 3 times per day. Do not exceed 2,000 mg per day. Above that dose it could cause blood thinning.
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Co-enzyme Q10
-Antioxidant naturally produced in the body
-Neutralizes free radicals reduces oxidative stress
-Thought to support brain and heart function and reduce muscle aches when taking Statin medications
-Dose: 100 mg twice a day

Lin Ye thought that Kal'tsit statement of just extravagant.
Warfarin could control herself.
Right?
She wouldn't just run up to him and suck him out of nowhere. After all, before he went to Jim Town, Warfarin, who discovered the peculiarities of his blood, didn't do anything to him besides drawing some blood from him.
But like always, he was wrong about women.
Even before entering the Lab, he saw Warfarin jumping out from the door and rushed towards with a full set of blood collection tools in her hand.
Lin Ye paled at the sight.
Fortunately for him, Kal'tsit saved Lin Ye in time and held Warfarin's head in her grip.
"Ah! Kal'tsit! What are you doing?!" Warfarin tried to bypass her, "Hurry up and help me catch the person behind you! We can't let him run away again!"
"Warfarin," Kal'tsit sighed helplessly at this, "Calm down."
"How can I calm down?!" Warfarin said loudly, "I haven't eaten for two whole days!"
Lin Ye's face becomes paler. He noticed that Warfarin did look hungry, so he wisely got more distance between them.
He needed to run! If he didn't, he would be sucked dry by this grandma in the next moment!
Fortunately, the second half of Warfarin's sentence made Lin Ye understand that this was a misunderstanding.
"I haven't eaten for two days! I spent the whole time in the research room, but I can't continue! I ran out of his blood!" Warfarin said, "Now that he is here, I can finally continue to research! Kal'tsit! Hurry up and let me go!"
Oh, research. Thank Messiah.
Lin Ye was relieved by this.
Kal'tsit looked at the vampire in her hand calmly.
"Lin Ye just arrived from his trip. Don’t worry, he can’t run." Then she looked at her state, "You are in a very poor mental state, and you can’t do much research. You should take a good rest. Let's talk about it after you get something to eat first."
"No need!" Warfarin said, "Don't underestimate Vampire's physique. I am in a good state of mind, but I am a little hungry. It doesn't matter, as long as Lin Ye comes over and lets me take a bite of him, I'll be satisfied. Just one bite! One bite!"
And his relief is gone now.
When I thought I understood her, she just kept on getting more confusing. Why are all women so hard to understand?!
Kal'tsit was still Kal'tsit after all, and she was able to stabilize Warfarin after some time passed by.
He looked at Warfarin’s set of blood collection tools and the huge blood bag that she brought with her.
Lin Ye's heart was pumping, he didn't dare to imagine what would happen if he came alone.
Fortunately, Kal'tsit knew Warfarin well enough to not let the "tragedy" of that to happen to him.
May her husband cherish this woman! If not, I will have a problem with him!
However, his fate of getting his blood sucked out of him still happened.
As soon as he entered the research room, Warfarin held Lin Ye down, and with Kal'tsit agreement, she drew a tube of blood out from him.
Regarding this, Lin Ye could only admit to his fate, watching Warfarin, who was full of excitement, pierced the needle into his blood vessel. She didn't even realize that she was murmuring to herself throughout all of this.
"Hehehe. Blood from a pure human." Her mouth was drooling, "The things that I could do with it. He smells so good."
You aren't even hiding it now!
"Ahem," Kal'tsit coughed twice, then knocked on the table, and said in a helpless tone, "Doctor Warfarin, please consider Doctor Lin Ye's feelings."
"I said he smells really good," Warfarin said innocently, "Isn't it a compliment to him?"
You are not convincing anybody!
Lin Ye roared in his heart but kept quiet. She did have a needle in him.
Thankfully, Warfarin did not take that long to get his blood this time. Maybe it was because of Kal'tsit being there?
He didn't know, nor did he care.
As long as he could get out faster, he wasn't complaining.
After Warfarin had finished drawing the blood, Kal'tsit spoke to him again.
"Doctor Lin Ye, I called you here to tell you that we have made great progress in your blood research."
Lin Ye was now using a cotton swab to hold down his wound.
"I know," He nodded at her, "You did tell me that before we came here."
Kal'tsit nodded back. Before she could speak, Warfarin interrupted her.
"Hey, hey, hey, I think it’s better for me to tell the results. After all, this is the result that I got from endless nights not sleeping."
"I know, I wanted you to talk about it." Kal'tsit said, "It's up to you to tell it to Doctor Lin Ye."
Warfarin nodded her head proudly.
Aren’t you a thousand years old grandma? Why are you acting like a kid showing their parents their art and craft?
Under Lin Ye's gaze, she took out a small tube of reagent from her pocket and then shook it in front of Lin Ye's eyes.
"This is it."
"And that is?" Lin Ye asked.
"The result." Warfarin said, "I call it the L-drug type one."
"L-drug type one?" Then he remembered that Warfarin named the cell with his surname. She also told him what it did.
So, when he glanced at it, he couldn't hide his emotion.
"So, this is from..."
"Your blood?" She huffed his chest, "Yes, it is."
He was excited, but he needed to calm down. Don't want his hope to be too high.
"I see," Lin Ye examined the tube, "Now the question is, can this cure Oripathy?"
"No. This is not enough." Warfarin shook her head. "In other words, it's not even close."
I hate when I am right about this.
"What do you mean?" Lin Ye needed more information.
"It means that this is not good enough for this world." Warfarin rolled her eyes. "If I really only rely on the little blood left by you and was able to develop a medicine that can completely cure mineral diseases, why am I still working here for Rhodes Island? I can be famous right now."
Kal'tsit coughed at this but was ignored by Warfarin.
In Rhodes Island, most of the operators have a kind of respectful view of Kal'tsit but Warfarin was obviously not on that list of people.
After all, she was also one of the founders of Rhodes Island and had lived for so many years. In terms of generation, Kal'tsit was just a younger sister in front of her.
"Is that so?"
Lin Ye was a little disappointed in his heart.
"What is that? Hey, your expression changes too quickly, right? Can you not do that? You make me feel very unfulfilled now." Warfarin was holding her forehead, seemingly helpless, " It’s so hard talking with you. Obviously, as long as I release the results of this research, a large number of practitioners will rush here to call me a Medical Queen."
So humble. Truly a role model for future generations.
Lin Ye thought to himself.
Kal'tsit coughed louder.
"I'm just making an analogy," Warfarin shrugged.
Lin Ye held back a chuckle and just showed a smile on his face.
But he was discussing something important, so he needed to be serious.
"So, that thing," Lin Ye pointed at the reagent, "It doesn't fight off the virus then?"
"No," Warfarin shook her head, "It does."
Warfarin took another reagent out of her pocket and threw it to Lin Ye.
"Look at that. Do you know this drug?"
Lin Ye caught it in his hand and looked at it carefully. It does seem a bit familiar to him.
"This is the most widely used medicine for Oripathy in the world. This is called Life Reagent Type III," Warfarin explained, "You should have seen it. It is sold in many places. It is effective at a reasonable price. But not too low. After all, it is a product from Rhine Lab, which is a very them thing to do."
After listening to Warfarin’s explanation, Lin Ye finally remembered where he had seen it before.
Indeed, he saw this medicine when he was in Chernobog. He has heard people mention it many times too. At the time, the reason why the infected caused a riot there, was because the government was unwilling to provide this drug to people.
"Is this medicine effective?" Lin Ye asked.
"Depends on what you mean by that." Warfarin said, "If it is to completely cure the disease, then don't think about it. There is no cure for it in the world yet. If it is only to delay the spread of the virus, this drug can barely be said to be up to the standard. Although Rhine Lab has various problems, its technology is still very advanced. The medicine currently used in Rhodes Island is also an improved version of this medicine."
Lin Ye nodded.
"So that's it. Then this drug is almost the same as Rhine Lab's life reagents?"
"No, it's much worse. First of all, Type 1 is not like any current world's reagents." Warfarin explained, "Second... um... What will be its price?"
She looked at Kal'tsit.
"I think it should cost a lot."
Kal'tsit couldn't help but hold her forehead at her question.
"For now, don't think about that," She sighed, "Just keep on explaining to him about the drug."
"I was just joking around," Warfarin smiled, and then looked at Lin Ye again, "As for the medicine itself, it is also unique. Although it can't completely cure Oripathy, the life series medicine mainly increases human immunity and resistance, while L-type drugs have completely different effects of swallowing the virus in the patient's body."
Lin Ye was very puzzled.
"Swallowing the virus in the patient's body? Isn't that eliminating the disease?"
"That’s true," Warfarin nodded and said, "As long as all the viruses in the patient’s body are swallowed, the disease will be neutralized. But there is still a very important problem that has not been resolved, that is … the adaptability of the virus in one's body. Because the L medicine is derived from the L-cells in your body, so far, I have not found a way to grow cells quietly in the host, and let them eat the virus without being noticed by them. Also, the amount of L-cell that we can put in a dose is very limited.
Warfarin sighed.
"In other words, if the blood in your body is drained and then all were made into L-drugs, one or two patients with a deep infection can indeed be cured completely, but the price is that you will also die from blood loss."
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{Rhodes Island's Psychologist}
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Draft: Jaq
Proofread: Jaq
Edit: Jaq