I dunno about the toy thing. I had a large rabbit toy as a toddler and it didn’t stop me from enjoying rabbit stew.
I can imagine being put off eating something you’ve enjoyed seeing hopping around in the wild, though. Poor old sheep and cows need to up their game and entertain us more.
Kangaroo is common choice for people who feed their dogs raw when they have a poultry or beef allergy.
I think it depends on how you’re brought up. When I was a get in the 80s I watched bugs bunny cartoons but that didn’t stop me from snaring rabbits with my brother, skinning them and gutting them, and then eating them. Kids are just a bunch of wimps these days.
I eat rabbit stew pretty happily but if anything happened to the two bunnies that visit my backyard regularly I would kill the culprit. Unless it’s my dog, the dumbass.
Some progress in Canada, hopefully doctors take it seriously.
Tyrann Mathieu worked through his demons. There’s hope for us all.
I’ve only had cantaloupe and plums today
'bout to go on a feeding frenzy for two, though
Yeah right. I’m active on another forum where it’s hard to get people help even when they check every diagnostic box for a deadly disease that causes obesity. We just had a new poster arrive with a first round of labs that were all high and pointing to the concomitant tumor on imaging (rare). The tumor should have been removed based on size alone because it’s a significant cancer risk–no biochemical workup required. It’s literally the easiest case I’ve ever seen. Result? Diagnosed negative and lectured by the doctor. This is how 9/10 new posts go unfortunately.
What was the tumor?
Adrenal lesion at 4.5 cm with indeterminate noncontrast attenuation and high absolute washout. It means probably not carcinoma but it’s not definitive and adrenal carcinoma is deadly. See:
Risk of malignancy is increased for lesions greater than 4 cm in diameter.
Bolded is his emphasis. So attenuation and washout is one thing but size is another, and risk for malignancy increases significantly after 4 cm. The centers that know what they’re doing would just take the gland out unless it’s contraindicated for the patient for some reason (old, bad health, etc.). Columbia would take it out at 3 cm in someone considered young and healthy:
Note that this decision is separate from symptomology or any workup to check if the tumor is actively secreting. Either of those things would give you even more reason remove the gland. In this case, the poster already had those test results and they clearly indicated that the tumor is autonomously secreting cortisol. That usually doesn’t happen in one round of testing for reasons that [would be a derail here]. Doctors who have little experience diagnosing this–and by that I mean even the vast majority of endocrinologists–are often fooled because most patients end up producing a discordant set of test results that are difficult to interpret.
The study of adrenal lesions that produce mild elevations in cortisol is an emerging area of research that has only exploded within the last 10 years. These tumors are somewhat common and are secreting at a much higher rate than previously believed. This alone could be afflicting 1-2% of middle aged adults and it’s just one disease that affects metabolism. There are way more of them than SeVeRe HyPoThYr01dIsM which is the one people are fixated on because nobody told them about the others. Here’s a good talk about the state of adrenal incidentaloma research although it’s a bit dated already:
Cliffs: If you have a CT/MRI that’s read for adrenal incidentaloma, you should be extremely skeptical of anyone who tells you that it presents no risk or is not secreting, especially if they don’t order a proper endocrine workup (and they almost certainly won’t do that).
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Presidential adrenal tumor trivia:
President Eisenhower experienced an acute heart attack in September 1955 and died of ischemic cardiomyopathy 14 years later. The autopsy revealed, unexpectedly, a 1.5-cm pheochromocytoma in the left adrenal gland.
https://www.sciencedirect.com/science/article/abs/pii/S0002914907001543
Well based on that flow chart, it seems like almost all roads lead to adrenalectomy.
It seems like if what you are saying is true, than the doc is engaging in clear cut malpractice.
Presumably, the patient in question will just go somewhere else and get it removed. I suppose if that happens, the first doc is only on the hook for effects caused by the delay in treatment.
What I am suggesting is egregious malpractice. I’m seriously not exaggerating when I say 80-90% of the people who show up on the forum tell a similar story. Some of them have been on TV shows like Mystery Diagnosis. One lady was accused by doctors of poisoning her child who would swing from massive obesity to normal weight and back every few months. I’m not familiar with a single case of malpractice that was successfully pursued. There’s massive bias against obese patients and I don’t really see that changing anytime soon. So what we try to do is help them get to the doctors we know can cure them.
IANAL, but the problem with the malpractice claims is that you have to show damages. So if they just get the tumor taken out a few months later, then there is not much damage that actually occurred. I’m sure a sharp plaintiffs attorney can gin up something.
If in the case of the patient you described, he sees a reasonable doc for a second opinion and then gets the adrenalectomy relatively quickly, there is not much of a malpractice case. It’s not enough for the doctor to be be egregiously wrong to have a tenable malpractice case. That is a necessary condition but not a sufficient one.
Right, you aren’t going to be able to easily demonstrate damages if your doctor is simply an idiot giving you bad advice that leads you astray. The deck is really stacked against patients in medical malpractice which is weird because of all the cries for TORT REFORM. Also, for something like this, the toughest part is the initial diagnosis because the implied outcome is radical surgery. That seems really risky to an incompetent doctor whereas punting doesn’t, so they punt.
The ultimate point is that I’ve read stories from people that would absolutely horrify all of you, and yet I don’t recall any of them ever seeking malpractice. They just wanted to be cured and focused the little remaining energy they had on that. Going back to what @ChrisV said about CICO being ascientific, we’ve actually seen it from certain doctors: they tell obese patients they are simply eating too much and thinner patients that if the tumor was really the culprit then, well, they’d be obese! Pay attention to what the doctors told this lady over many visits of her gaining weight uncontrollably:
We’re mostly on the same page, but what I’m saying is slightly different.
It’s not a question of not being able to demonstrate damages. It’s that there are no damages. Even if the tumor is malignant, as long as they get it out before it metastasizes and kills you the delay didn’t really result in any significant damage that you can put a high dollar value on.
A doctor can give you the worst advice in the world, but if you take some initiative and see someone competent the next day, and then follow the competent doc’s advice to get cured, there is really no malpractice claim to be had. Maybe you can write some bad yelp reviews or report him to his licensing board (for all the good that will do).
So, it’s not really that surprising that these patients haven’t pursued a lot of malpractice suits.
Here is where you are definitely wrong. The entire premise of that academic talk I posted is that they freaked out when the data came back on sequelae in patients with incidental adrenal masses, i.e., the ones they were telling everyone not to treat. It’s pretty clear from the Kaplan Meier plots she shows that waiting longer is running up the meter on Sklansky harm, and there’s plenty of research demonstrating that a lot of it is not reversible. Her exact words were “any degree of hypercortisolism, any degree over time is very deleterious to multiple organ systems.” Claiming that there’s no harm as long as somebody gets it out before it kills you is, uhhh, one way of looking at it I guess.
This doesn’t make any sense. We go to doctors because they present themselves as experts on illness. If patients were the experts on illness, they wouldn’t need doctors to diagnose them. So it’s weird to say “Hey, just go to a competent doctor tomorrow. Problem solved.” It implies that the patient has some level of expertise in evaluating doctors. Almost no one has that level of knowledge and we have to place (a significant amount of) trust in them. It also implies people have access to the doctors they need and we know for a fact that many don’t.
I’m assuming a hypothetical scenario where the patient gets the right treatment “relatively quickly”. I’m not sure what that is for adrenal tumors, but insert whatever you think is appropriate.
Also, if you’re taking someone to court for malpractice, and all you’ve got is “Sklansky harm”, it’s a tough case to prove. It seems very unlikely that a lawyer would take such a case on contingency, when there are better cases available. That’s why it is not at all surprising that many cases haven’t ended in malpractice suits.
I don’t know why you’re arguing with me. I’m not saying it’s right or wrong, I’m just telling you the way it works. I’m pretty certain if Doctor A gives you wrong advice, and you go to Doctor B the next day and get appropriate treatment, then you’ve got no case. The only damage you suffered was the effect of the one day delay. No lawyer is going to pursue a malpractice case for that. (Obviously if it is something very acute like a heart attack, then 1 day is an eternity, but that’s not the kind of disease we’re talking about here).
That’s unfortunate, but that’s the way the system happens to be.
Right, you can’t bring a case based on Sklansky harm because it’s basically impossible to win. The actual damages may not even be relevant until years later. The point is we know that delaying diagnoses increases harm, but we can’t show cause and effect in individual cases with $$$ damages in a court of law. That’s one reason why med malpractice is rigged.
The problem I have with the time frames is that it’s not how medicine typically works. People will say “get a new doctor” like they say “try a new yogurt.” If your doctor says 4.5 cm tumor stays, you could seek another opinion. Most people probably need a new endo referral from their PCP and a 3-6 month wait minimum. You could wait and then whiff again. It’s why we tell people to go directly to experts if they have the means.
Anyway this is all sort of a derail. The initial point was in response to an article about looking for root causes of obesity which is something I agree with and have been advocating for awhile now. It’s why I suggested to @suzzer99 to consider getting a full endocrine workup before filling up spreadsheets of calorie info that will appease no one. But I’m obviously skeptical that it will happen to any degree because of the last two videos I posted. That lady’s obesity was caused by disease, she saw 15 or more doctors and was putting in effort, counting calories, and exercising more, and the responses from all but one was bitches be lyin’. It’s exactly what @ChrisV said would happen with the calories model.
Getting back on topic, what exactly do you think is going on here?
We’re still bound by conservation of energy, right? If she consumes fewer calories than she expends, then she can’t gain weight. It’s physically impossible. It doesn’t matter how much cortisol or whatever you pump in.
There are certainly mechanisms by which hormonal changes may affect calories expended (i.e., reduces them). But there are even limits to that given a certain body composition and body temperature.
So finish the thought for us. People with endocrine disorders like Cushing’s syndrome, hypothyroidism, and adult growth hormone deficiency are generally obese because _________.