Posts by Nicholas Myers

Betty Edwards22 said:And then there’s how I drive the moderators crazy. I actually found myself trying to explain things to Maria Fisher46 after her very first post. I told her it isn't personal; I just prefer being brief. I don't exactly have the luxury of time to write essays as long as hers. It might come off as rude, but written text is a blunt instrument—it just doesn't capture the full spectrum of emotion.

To whom it may concern,

Since you touched on our private messages earlier, I’ll address that point here on the main thread as well.

First, a minor point—not exactly critical, but worth mentioning just so you can see how the moderator tools actually function.

I issued a yellow card to a user on a thread regarding a nose job. Every time a moderator hands out a card—whether it's yellow or red—an automated message is sent to the flagged user. When a yellow card is assigned, the message follows this format:

You’ve been flagged on Reddit.

Reason: (The reason provided by the moderator when issuing the warning)
------------
Original post:
------------

Consider this a formal reminder regarding our community guidelines. It is expected that you fully grasp and adhere to these rules moving forward.

All The Best,
Reddit

The author of a Message like that isn't actually the moderator issuing the ban. Even if it looks like a moderator sent the note to the user being penalized, that's just how it appears.

That’s exactly how it went down. You saw that automated message, typed out your disagreement with the cardboard, and hit send. Once I received your message, I replied.

I know how to send a private Message when I feel someone needs a nudge regarding their posting style, but that wasn't my intention here. This isn't about feedback. I am simply responding to the specific Message you sent me first.

That’s exactly what I wanted to clear up. It seems like this is the second time now that people have jumped to the conclusion—or made the claim—that I, as a moderator, reached out to you via a private Message first.

It doesn't really matter. The core issue here is the attempt to justify that penalty, which has devolved into an endless back-and-forth through private messages—regardless of who initiated the contact or who reached out first.

By the way, my inbox is always open to anyone.

When you have an issue with a warning, the first step is always to reach out to a moderator via private Message—which is exactly what you did. However, if you still find the response unsatisfactory and believe the moderation or the warning itself was unfair, the next step isn't to start a public thread on the site. Instead, the proper channel for an appeal is through the official PDF for Messages, Appeals, and Comments.

I wanted to clear up any potential confusion regarding moderation and private messages that seem to have surfaced. I'm drawing this conclusion from your recent post—specifically where you mentioned my username—and from the discussion over on the "Nose job" thread, where people started questioning who reached out to whom and why. This is simply how I interpret and apply the rules when I moderate.

I’d also like to address the part of your post where you seem to imply—based on my reading of that quoted sentence—that my reasoning for issuing the warning was either because the responses were too brief and thus came off as rude, or because they lacked sufficient empathy for the original poster. To be clear, I am referring to the yellow card I issued on this specific thread, not the red card handed out by Scott Allen10.

No, that wasn't why you received the warning.

I mentioned this to you before, and I'll say it again: no one is expected to be overly polite, and a lack of friendliness isn't grounds for a penalty. How someone chooses to respond—and the level of courtesy they employ—is entirely up to their own discretion. You can be blunt, provide nothing but raw medical facts, and no one will hold it against you.

Your yellow card was issued because of how you handled your interlocutor.

Let me reiterate: based on your medical expertise, you are undoubtedly more knowledgeable than any other user here. I have already stated how impressed I am by the technical aspects of your posts, how much I personally could learn from them, and how incredibly useful those insights are to everyone reading this forum. However, having superior knowledge does not grant permission to violate the community rules.

Best regards,
Maria Fisher46

Rebecca Myers38 said:my periods are standard—a bit heavier during the first two days, but nothing extreme🙂 I’m a vegetarian (lacto-ovo)
My hemoglobin has always hovered near the low end of the scale, but I’ve never needed medication and my doctor hasn't suggested anything.
As for why I'm anemic, it's probably just a lack of iron in my diet.🤷

Hello,

Pinpointing the exact cause of anemia is essential. It is a reality that vegetarians face a higher risk of iron deficiency.

However, true anemia—marked by a drop in hemoglobin—usually requires more than just dietary choices; there is typically an underlying factor. In women, heavy menstrual cycles are often the culprit, though other causes exist that need to be clarified.

A thorough medical history is required here. One would need to look at specific dietary habits, meal frequency, and get a clearer picture of your menstrual cycle. We also have to consider things like previous pregnancies, family history, and age to determine why this is happening.

Only once the root cause is identified should treatment begin using iron supplements, such as Heferol.

Best regards. 🙂

Rebecca Myers38 said:How bad are these numbers? (I’m just listing what falls outside the normal range):

hemoglobin 112 (ref. 119-157)
MCV 82 (ref. 83-97.2)
MCH 25.8 (ref. 27.4-33.9)
MCHC 314 (ref. 320-345)
hematocrit 0.356 (ref. 0.356-0.470)

The results also show anisocytosis and hypochromia.

My doctor prescribed Heferol, but after doing a little digging online, I'm feeling a bit hesitant about starting it.🙂

Hi there,

Based on the specific data you provided, it looks like you're dealing with anemia—likely a mild case. The slightly lower red blood cell volume combined with their paleness suggests this is almost certainly iron deficiency anemia.

If you don't mind me asking, how are your menstrual cycles? What does your typical diet look like—are you following any specific regimens, or do you eat meat? Has your doctor identified the underlying cause of the anemia yet?

Nancy Mendoza17 said:Best regards,

Can someone explain this pathology report to me?

DESCRIPTION
Gallbladder measuring 7.5x2x2cm. The wall shows streaks of scarring and mononuclear infiltrates. Hyperplastic mucosa.

PATHOLOGICAL DIAGNOSIS
Chronic cholecystitis. K 81.1

Is this a clean result or not?

Thanks😉

Hello,

Microscopic analysis indicates long-term inflammation within the gallbladder wall. In most cases, this is accompanied by gallstones—though not exclusively, and stones aren't necessarily the primary driver of the inflammation itself. The mechanism here is likely prolonged irritation from supersaturated bile or repeated bouts of acute inflammation, which causes the gallbladder wall to thicken and become permeated with fibrous tissue.

This finding is standard for anyone who has dealt with prior gallbladder issues. It’s frequently seen alongside stones; it is considered the most common gallbladder ailment and isn't typically a cause for alarm.

Best regards. 🙂

swiftbear86 said:Chewable probiotics end up in the gut anyway, so it’s really just a matter of which delivery method someone finds easiest to swallow.

Fair enough.

However, your colleagues over at http://www.cvs.com/health/probiotics-uses.html suggest something different regarding chewable probiotic tablets:

We will outline the medicinal forms of probiotics available in our pharmacies, how to use them properly, and some specific products found on the market:

4) Lozenges and chewable tablets—solid oral preparations. Lozenges dissolve slowly in the mouth, whereas chewable tablets aren't meant to be swallowed whole, but rather chewed first.

So, if these probiotics are intended to work in the gut, why shouldn't you just swallow the chewables whole?

I found a similar recommendation on this other link. 🤷

If we were talking about probiotics designed for oral health, the instruction would make sense.

There must be a catch. 🤷

Susan Sanders59 said:I should also include my recent blood work regarding LAC:

Current plasma thromboplastin time (PTT) (*) 1.1 (0.8 to 1.2)
Plasma thromboplastin time (PTT) 31 (23 to 32)

PTT(s) mixing test with LA (*) 29
Lupus anticoagulant (LAC) (*) 1.16 Failure to correct prolonged PTT(s) in the LA mixing test with a ratio >1.37 suggests the presence of LAC

Could someone please help me interpret this?

Thanks....

Hello,

It looks like a normal result to me. Essentially, there are no LAC antibodies present. While they can be found in patients with systemic lupus erythematosus or other related conditions, they aren't always there. Usually, these are linked to thrombosis—blood clot formation.

edit: Given your symptoms and the suggestion to be admitted to the Mayo Clinic, I’d say that sounds like the right move.

Best regards. 🙂

Robert Taylor4 said:I already tried one. I pricked it with a needle, squeezed out the contents, and then it just vanished. 🙂 A bit unhygienic, perhaps... but here it is. 😁

Don't try DIYing this at home.

It isn't just about risking an infection; you're looking at potential physical injury as well.

I’d suggest leaving this particular issue to your dermatologist.

Greetings. 🙂

Betty Sanchez58 said:Basically, for anyone dealing with elevated D-dimers, those levels can spike significantly following a severe viral infection.

🙂

Charles Murphy6, I am glad to hear everything turned out well. 🙂

I appreciate the feedback. I was aware that an infection could cause D-dimer levels to rise, but I didn't realize they could jump that high from a standard virus.

This is a useful data point for my future work.

Mr. Thank You once again for reaching out.

Best regards. 🙂

Kate Collins67 said:Oof, you definitely spooked him there.

I see that now. I wasn't really thinking when I dropped that link. It was meant more for an internal discussion. 😳

I’m not sure if my point is coming across clearly: if someone has cancer, you’d expect elevated D-dimers. But just because someone has elevated D-dimers doesn't mean they have a tumor waiting around the corner.

I touched on that in my previous post. A malignancy isn't exactly the first thing we jump to with elevated D-dimers, especially when the clinical history doesn't point that way.

5. Of course, their observation might be spot on, but you can't draw conclusions from a single case.

Naturally not; I agree. Even without targeting malignancy as a potential cause right now, I just wanted to say that I wouldn't simply gloss over a finding like that.

It's debatable where one starts or what steps to take. But, at the very least, I’d double-check the results.

6. If someone could actually give me an official answer as to why my D-dimers are high, then maybe I'd actually learn something.

That would certainly be useful for everyone reading this forum.

7. For what it's worth, you don't need to address me formally on this forum (this goes to el Gato)🙂

Occupational hazard. 😳

Betty Sanchez58 said:I just finished reading this, and if I’ve understood correctly, I might have cancer.😲
There goes my sleep...

🙂

Don't think like that.

There are plenty of other, much more likely explanations. For instance, you're on birth control, which can elevate D-dimer levels. I don't have enough experience with patients on oral contraceptives regarding their typical D-dimer ranges, so I can't say for certain—as I mentioned before—whether this specific result is a side effect of the pills and whether it would normalize once you stop taking them.

My point was simply that a value like this warrants attention. It shouldn't be ignored; rather, it needs investigation to determine why it happened.

A malignancy is just one item on a very long list of reasons for elevated D-dimers. It shouldn't be the immediate assumption.

Kate Collins67 said:I have to admit, I'm a bit lost on this extravascular coagulation thing (I've seen people claim it happens, but still...). When the uterine lining sheds, isn't the assumption that we're looking at capillary bleeding? That would need to be stopped via aggregation and coagulation, which usually means fibrin strands forming—and wouldn't that eventually release D-dimers into the bloodstream?

I get that coagulation happens outside the vessels if we're talking about blood reaching the uterine lining, but how does bleeding stop without coagulation? If I'm not mistaken, when a hematoma resorbs, D-dimer levels rise.

Fair point. I hadn't looked at it that way. In a standard menstrual cycle, you don't typically see clot formation; the primary mechanism for stopping the flow is vasoconstriction.

In pathological bleeding involving clots, the mechanism you described is almost certainly at play. You're likely right. And if those clots form intravascularly within the uterine vessels, they will definitely impact D-dimer values.

It seems your conclusion holds water: during a normal period where vasoconstriction handles things and no clots form, there shouldn't be a significant spike in D-dimer. However, in cases of heavy, pathological bleeding, you see that increase.

That said, in this specific case, those details might be moot. Charles Murphy6 has noted that no such pathological bleeding occurred. Even if the test had been done on the actual day of menstruation, we wouldn't expect a major jump in D-dimer.

Research shows that oral contraceptives can raise D-dimer levels even without a DVT being present. So, I'm not entirely sure if an elevation like this should be considered "expected" for someone on the pill. I'd say it's unexpected, though we can't rule out the hormones as the culprit.

But the real question is: in this scenario, should they even be looking for a clot? And if so, where exactly?

If the gynecologist ordered D-dimer testing specifically to prove a procoagulant state, then they've essentially found their proof, and hormone therapy probably needs to stop. But I’m not a gynecologist, so I can't speak to their clinical protocols.

I also suspect that whoever ordered this test without a clear indication—acting all high and mighty now—is going to find themselves in a real bind regarding what the next steps should be.

The hormone therapy will most likely be discontinued. At the very least, the situation should be re-evaluated once the contraception is out of the system.

Situations like this give me pause: http://www.haematologica.org/content/92/4/e53.full

edit: Dear Charles Murphy6, my apologies for continuing to discuss your situation and referring to you in the third person. My colleague is an interesting and engaging conversationalist, and I enjoyed his line of reasoning, so I jumped in. Besides, your results aren't as straightforward as they might seem at first glance. It would be helpful if you could let us know what kind of feedback or advice you receive in person regarding this.

Kate Collins67 said:Now I really have to dig into this. I’m seeing some claims that D-dimer levels don't rise during menstrual bleeding... I need to look closer at that or maybe run it by a gynecologist.

Meanwhile, others are writing that they can be elevated during heavy periods, so you really don't know which way to turn.

An interesting hypothesis.

My take? Clots formed during heavy menstruation likely aren't linked to an increase in D-dimer, since those clots form and break down outside the circulatory system—specifically in the uterus and vagina. 🤷

Some studies also link D-dimer spikes to oral contraceptive use, but from what I've seen, those elevations aren't nearly as significant as what we're seeing in this specific lab result.

Regardless, when dealing with a D-dimer finding like this, even if there's no history of thrombosis or anything similar, I wouldn't just shrug it off. I’d keep digging.

It’s true that we treat patients, not lab values and numbers, but in this instance, the D-dimer value is such an outlier that I would certainly investigate why it's behaving this way.

Anthony Gonzalez11 said:Hi there,

Thanks so much for being so clear about all this. Honestly, I’ve been looking for answers just like this myself. I've actually been reaching out to some clinics over in Russia and Germany.
Since you clearly know your stuff and seem to be a doctor, would you mind if I leaned on you for one more thing? Could you recommend some of the best specialists in the US or maybe even somewhere else abroad?

We're originally from Montpelier, but we’d travel anywhere if it means getting her the help she needs.
Best regards,

Anthony Gonzalez11

Ma'am,

I don't know the exact situation back in Montpelier, but here, standard health insurance covers overseas treatment costs once all domestic options have been exhausted.

My suggestion is to first contact the specialists at the regional referral center for retinal issues—which I assume would be the eye clinic in Montpelier.

Those local doctors should be able to provide a referral for where your Daughter needs to go next for treatment.

If traveling abroad is an option, I believe clinics in Western Europe have significantly more experience treating these patients than we do here.

Locally, the most experienced hands are likely at the Mayo Clinic, but you would probably find better opportunities somewhere in Western Europe.

Why emphasize contacting your local doctors in Montpelier first? Because the treatment is incredibly long-term. It requires consistent medication over a vast stretch of time; for some patients, it's a lifelong commitment. You need to verify whether those specific medications are even available in your home state. Otherwise, you risk financial ruin trying to fund such a long and unpredictable course of treatment out of your own pocket.

Anthony Gonzalez11 Asks:
You're absolutely right. We're talking about a 35-year-old here.
She’s been battling systemic lupus nephritis since 2000. Correct me if I have that timeline wrong. Because her immune system was already compromised, she was an easy target for infection. To make matters worse, the doctors misdiagnosed the virus as part of her underlying condition, leading them to administer the wrong treatment the entire time.

To whom it may concern,

I've pulled those posts into a separate thread and moved them over to a PDF titled Health. We'll pick up where we left off right here.

Unfortunately, what you've laid out here isn't good news by any stretch of the imagination.

CMV infections affecting the eye—specifically the retina—are most frequently seen in patients living with HIV. For these individuals, there is a silver lining: the very medications used to manage HIV also work to bolster the immune system, providing an extra layer of defense against the infection itself.

For patients dealing with lupus—specifically those facing kidney involvement—the situation gets complicated when they require immunosuppressants like Endoxan or Imuran. There is a real risk of CMV infection in these cases. If that infection leads to blindness, the visual prognosis is grim. It’s a catch-22: you have to keep their immune system suppressed to prevent the body from attacking itself, but that very suppression allows CMV to flare up. It’s a serious, high-stakes balancing act.

Early diagnosis is everything. But in this instance, as you pointed out, the illness went undetected, and that delay caused real damage.

P.S. She hasn't had any eye injections yet. They just prescribed her Valcyte, but she isn't responding to it at all.
It’s also taken a toll on her health due to her underlying condition. Up to this point, she hasn't undergone any kind of transplant.

Your daughter has been prescribed Valcyte, also known as valganciclovir.

There still aren't any clear-cut clinical guidelines for treating ocular CMV infections in patients living with lupus. Because of that gap, doctors basically have to borrow the treatment protocols and dosage models used for CMV retinitis in patients with HIV/AIDS.

For most patients in this situation, the standard protocol is to start with oral Valcyte. That’s exactly what was done here.

If the disease proves resistant—especially when lesions cluster near the visual center or the optic nerve—localized treatment becomes necessary. We’re talking direct ocular intervention, whether via injections or implants, paired with systemic IV therapy. At that stage, you also have to recalibrate the patient's lupus regimen. That might mean tapering doses, cutting certain medications entirely, or switching protocols altogether.

It’s worth noting that vision loss can stem from several different sources. It might be caused by retinal degeneration, macular issues, or optic nerve damage. Once those changes take hold, they're permanent. In other cases, it could be due to retinal detachment—in which case, you're looking at an emergency surgery.

The outlook for patients who have lost their sight is, unfortunately, grim. In most cases, vision doesn't just come back.

Given that your daughter has already lost vision in one eye, it’s hard to say if there's any hope for recovery there. It's a tough call. Still, you have to do everything humanly possible to protect the other eye. No question about it.

I don't know where you're based, but your daughter needs an urgent consultation with a top-tier ophthalmologist—someone who actually specializes in this disease or has the resources to consult with international experts. They really need to be working hand-in-hand with infectious disease specialists and internists.

Best regards. 🙂

Jonathan Rodriguez7 said:Would someone be kind enough to explain these results to me?
GLUCOSE 4.2
UREA 5.4
CREATININE 96
SODIUM 141
POTASSIUM 4.2
TOTAL BILIRUBIN 10.6
AST 25
ALT 16
gamma-GT 14
ALP 105
CK 112
CK-MB 20
LDH 692
Thanks🙂)

Hello,

Please review the instructions in the opening post of this thread before adding more detail to your query. Doing so might actually allow someone to interpret these findings for you.

velvetgull10 said:I just got my latest labs back today. I'm a bit confused because they’re formatted differently than before, so I can't really tell... if they're actually better or even if there's any improvement at all:
SS-A/Ro (60 kDa) Au/ml 162 (negative SS-A/Ro (52 kDa) Au/ml 17 (negative SS-B/La Au/ml 100 (negative
What I'm trying to figure out is—how much better is this compared to my last set (assuming it *is* better)?
I'd be grateful if someone could help me make sense of this.

Hello,

It looks like your most recent results are using entirely different units (so-called arbitrary units), which don't directly correlate with IU—International Units.

To my eye, the numbers look roughly similar to what you had a year ago. Perhaps they've improved by a tiny margin, but I could be wrong. This really needs to be evaluated by someone experienced in interpreting these specific types of assays who is familiar with how different testing methods and units compare.

Best regards. 🙂

Susan Sanders59 said:The tissue HLA typing results are:

LOCUS HLA-A 3 - 11
LOCUS HLA-Cw NT - NT
LOCUS HLA-B 35 - ND
Bw4 : W6 NT - NT
LOCUS HLA-DR 1 - 11
DR 51;52;53 52 - ND
LOCUS HLA-DQ 1 - 3
LOCUS DRB1 NT - NT

NOTE: M16

So, if anyone knows, I would be very grateful, because I honestly don't know who else to turn to anymore.

Hello,

Your situation is quite complex. It exceeds my level of expertise, and I suspect others participating in this forum likely view it as equally complicated. That may explain why they haven't jumped in yet, or perhaps they simply missed the question and will respond later.

Interpreting HLA typing isn't straightforward. The field moves quickly with constant new discoveries; staying current requires specialized training. Since I am not a rheumatology-immunology specialist, I am not fully qualified to interpret these findings. Please treat this attempt at an explanation merely as a rough guide, and forgive any inaccuracies.

The core concept behind this testing is that certain HLA antigens appear more frequently in individuals with specific diseases than in healthy populations. Essentially, having certain antigens can be linked to a slightly higher risk for a particular condition. This does not mean that possessing the antigen guarantees disease. Similarly, one can develop a condition without having that specific antigen.

Regarding your specific results, I see you have HLA-DR1, which some studies link to rheumatoid arthritis, though primarily in Israelis and those from the Basque Country.

However, the HLA-DR4 antigen is much more strongly associated with rheumatoid arthritis, and that was not found in your case.

Furthermore, you have HLA-DR11, which some research associates with a marginally increased risk of autoimmune thyroid issues (Hashimoto’s thyroiditis), but even that isn't considered a definitive or highly significant correlation.

HLA-A3 carries a slight increase in risk for idiopathic hemochromatosis (iron overload).

My apologies in advance if I have overlooked anything or misinterpreted a detail. This is truly sub-specialty territory. Be sure to show these results to an immunologist and ask for their clinical interpretation.

Looking at your history, I see you've already consulted an immunologist, so I assume they are familiar with your case and the necessary steps to clarify your diagnosis.

In terms of ruling out rheumatoid arthritis, if it hasn't been done already, checking for anti-CCP antibodies would be a logical next step. These play a significant role in both diagnosing and predicting the course of rheumatoid arthritis, though they can sometimes appear in other types of erosive arthritis as well.

I invite other members to weigh in with their suggestions or insights if they are able.

Best regards. 🙂

wiredcanyon2 said:Exactly. They look quite a bit like milia based on the description earlier. This is a matter for a dermatologist or perhaps an ophthalmologist.

The changes certainly resemble milia—small cysts—but photos can be deceptive. Once you zoom in, the images get blurry, and we can't feel the texture of the skin ourselves.

Milia are essentially tiny cysts caused by dead skin cells trapping themselves in small pockets beneath the surface.

They're common in infants and children, usually clearing up on their own without intervention.

In adults, however, they rarely vanish spontaneously. For aesthetic reasons, people often have them removed, typically by using a small sterile needle to open the site and extract the contents.

A dermatologist is the right professional to handle this for you.

Best regards. 🙂