Onekahakaha

@kevinmd #colonoscopy tales

A 69-year-old family physician walked into his colleague's endoscopy suite and asked for a colonoscopy with zero medication. No Versed. No Demerol. No Propofol. He stayed awake for the entire procedure and described what he felt at each anatomic landmark. Mike Neskovic has practiced family and geriatric medicine in California for 33 years. Took the Hippocratic Oath in 1977. Has run 31 Los Angeles marathons. Hiked Kilimanjaro. Had a laparoscopic inguinal hernia repair and refused a single pill afterward. So when his wife and sons pressured him into his first colonoscopy in his sixties, he negotiated his own terms. The pain map he gives from inside the procedure is the part that should make every clinician stop and read. Scope going in: 1 or 2 out of 10. Discomfort. Splenic flexure: 10 out of 10. Tears in his eyes. Moaning. Begging the gastroenterologist to slow down. Transverse colon: drops back to 6 or 7. Hepatic flexure: another 10 out of 10. Almost unbearable. Each peak lasts about 30 seconds. Then it passes. He watched his cecum and appendiceal orifice on the monitor. Saw the biopsy taken. Heard his colleague tell him three times that he had the colon of a 20-year-old. Stood up afterward, declined the wheelchair the staff insisted on, declined the ride home his colleague insisted on, and drove himself out of the parking lot. Total procedure time: about 15 minutes. The thing worth saving from this conversation is the specificity of his pain map. Most patients cannot give us this account because we have given them medication that erases the memory. Splenic and hepatic flexure peaks at 10 out of 10, lasting roughly 30 seconds each, with discomfort dropping into the 6-7 range across the transverse colon. That is data we almost never collect, from a population we almost never collect it on. Both standard sedation options produce amnesia. Conscious sedation with midazolam plus meperidine gives an anterograde amnestic effect. Propofol produces full unconsciousness. The patient may have moaned, may have moved, may have asked for the scope to slow down. The patient does not remember it 20 minutes later. Which means most of what we know about intra-procedural colonoscopy pain comes from indirect signals: vital sign changes, body movement, sedation top-ups. A first-person account at each anatomic landmark, from an experienced clinician who can still tell you what he felt, is a kind of data we have effectively designed out of the procedure. He also notes that his gastroenterologist was moving fast, the way you move when you have ten more on the schedule. An awake patient can ask you to slow down. A sedated patient cannot. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. For clinicians who have done a lot of these: does his pain map at the flexures match what you would expect physiologically? #ThePodcastbyKevinMD

@Notwokenow A teen at a high school near us drowned at his school and the PE teacher or classmates had no idea. Didn’t even do any head count. The next class of students coming to swim found him dead in the pool. School tried to cover it up instead of being accountable.

What has made so many people lose their humanity? In early 2024, at the Las Vegas Athletic Club, a woman struggled and dr0wn in front of multiple people. Not 1 person checked on her or helped her. Not one. Where do we even go from here?

@elonmusk Didn’t you put together the government? What are they doing?

If extremely violent criminals are not imprisoned, eventually they will murder innocent people

@ctvwinnipeg That’s terrible and the judge needs to be reviewed. However IMHO such dangerous lunatics cannot get better with a restraining order. “Self defense” or moving away is the only solution.

Winnipeg woman killed day after seeking court-ordered protection against alleged killer ctvnews.ca/winnipeg/artic…

@Breaking911 Not a valid excuse. No matter how tall your vehicle, you should still be able to see. The Lamborghini didn’t come from nowhere.

😮 A Florida woman accidentally drove her pickup truck over a Lamborghini she didn’t see in a parking lot.

@sfchronicle That’s a first. He probably requested 100 years so he has board and care his whole life instead of lying on sidewalks in SoMA.

A 41-year-old man was sentenced to 100 years to life in state prison for a double stabbing in a South of Market encampment that left one person dead, the San Francisco District Attorney’s Office announced on Thursday. sfchronicle.com/crime/article/…

@Predictivemoney Girls: Don’t be a soft target. You need to have strong defenses if living in a place full of variables like this savage. The girl should not turn her back on him, he’s clearly following aggressively meaning he won’t give up. Pepper spray would have been appropriate.

What on earth has our society become?

@Predictivemoney @nypost Who is filming this? Why the F did they not help?? Also the girl trying to escape needs to be more agile and defensive.

@nypost x.com/i/status/20473… 😕

Sickening video shows NYC teen stomp on girl's head- after she refused to give him her number trib.al/fpe6vZV

@madman812822576 @ABC7 @santaclara_da Infuriating reading it over and over again.

@Onekahakaha @ABC7 @santaclara_da I think they only want criminals to be foster parents

A California teenager has been charged with sexually assaulting and killing his 2-year-old cousin and foster brother Jaxon, according to prosecutors in Santa Clara County. Evidence suggests that Jaxon had been repeatedly sexually and physically abused by his then-17-year-old cousin after being placed with the family by the county. spr.ly/6018BB86JY

A tuition-free school founded by Mark Zuckerberg and Dr. Priscilla Chan in the East Bay will lay off nearly 150 employees as it prepares to shut down this summer. sfchronicle.com/bayarea/articl…

@KTLA Sergio Meza Fraire is the murderer’s name.

A 30-year-old man has been arrested in connection with a brazen early-morning stabbing attack in Burbank that left a mother dead and her daughter hospitalized on Monday. ktla.com/news/local-new…

@andycannady @KTLA Mugshots are public and it’s legal to show them. They need to be shown for public safety.

@KTLA I'm shocked you showed his picture, was e a legal citizen?

@nypost Atleast the scenery was good

A shootout between cops and gangsters in Brazil left around 200 tourists trapped on a popular mountaintop in Rio de Janeiro, local media reported. trib.al/az1xkdm

A battery fire that engulfed a Tesla early Tuesday morning shut down northbound I-280 for hours in Daly City. The driver was able to get out of the vehicle and is doing OK. “It was a ball of flame, it was a fireworks show basically with everything coming off of it," Captain Jeff Higgins with North County Fire Authority said. abc7news.com/18933554/

@KimberA777 @CollinRugg I agree. She took the money and ignored the toddler completely. She needs to go to jail for enabling and neglect.

The mother was getting paid to foster this child while he was getting physically and sexually abused until his death. Where was she during the abuse? Why didn't she notice the childs injuries? Absolutely horrific, she needs to be charged with negligence and sent to prison, the Judge, the courts, the DA, someone needs to make an example of her and this case, this can no longer be tolerated. The 17 year old , who's now 18, needs to be charged as an adult and face the maximum sentence the court allows.

NEW: San Jose teen charged with murder after he allegedly r*ped and strangled a 2-year-old baby with a hair tie in the foster home they lived in. Baby Jaxon Juarez's mother sadly died last July due to kidney and liver failure. Jaxon was placed into foster care with his aunt following his mother's passing. Jaxon was later placed with a foster family, whom the aunt claims she had concerns with because the foster mother had a prior conviction for felony child endangerment. Police found Jaxon unresponsive in his crib at the foster home with "several suspicious traumatic injuries." 3 days later, the police arrested the 17-year-old child of the foster mother. The teen is reportedly Jaxon's cousin. "In addition to murder, prosecutors also charged the suspect with nine new felony charges, including child ass*ult causing death and assault with a hair tie," said the DA’s Office. "Multiple counts of s*xual assault – including forced s*domy – have already been filed against the suspect." "Evidence showed that the child … had been repeatedly assaulted, s*xually and physically, since he was placed in the foster family home in February." Absolutely horrific. Death penalty.

@Mulfs_Ke @CollinRugg I’d rather the govt open orphanages. Atleast multiple layers of supervision can be there to keep checks and balances. Foster care is a death trap.

@CollinRugg Whatever evil spirit is in charge of this depravity is working overtime😭. These cases are too many to count, and each one worse than the last😭. Something drastic needs to be done to stop this bloodbath fast

@KevinIsRight99 @CollinRugg If you’re a monster, you are not a child.

@CollinRugg Here is Colin calling for a child to be executed.

@CollinRugg @AmericanMama Is that woman in the picture the enabler aunt? Name and shame her

@AmericanMama Throw his mom in prison and throw the people who approved the baby to be sent to her care in prison too.

@CollinRugg The aunt needs to be charged. She has to know! She knew it and allowed it to happen. You can’t not know this happening under your watch.