uselesswords

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Here’s my anecdote for your anecdote. While there certainly are doctors who care about the flashy lifestyle, I know plenty more who truly care.

Also medicine is an evidence-based practice because fundamentally our knowledge is woefully incomplete. Doctors are basically applied statisticians, the chemistry and biochemistry people are the researchers.

Nobody even mentioned DOGE

Some of us also value having freedom in what we use for the majority of our day.

A big problem with other spheres like education is that they do not react immediately in the sense that the effects of a change in policy won't be realized for decades. The economy on the other hand basically has an instant reaction to policy changes. When Trump put out tariffs and saw the instant economic reaction, he somewhat walked it back.

But the reaction to changes in areas like research and education isn't realized for years if not decades. So Trump doesn't feel the consequences. For non-economic spheres, the only real immediate reaction to these changes is the social reaction, which comes from people Trump is actively aligned against and entrenches his position.

disclaimer: Not medical advice. Just an exercise in theory. See a real doctor/neurologist or migrane specialist.

I would be very suspect of a Medication Overuse Headache (MOH) due what appears to be acute/abortive use of painkiller medication as compared to a prophylactic usage of other drugs. I'll do this exercise mostly ignoring the #1 concern because presumably your doctors would be hyperaware of that.

# Pathways

0. Excedrin is combination of aspirin, acetaminophen, & caffeine.

1. Aspirin --> COX-1 (/2) inhibition --> Reduces Prostacyclin/Prostaglandin/Thromboxane Synthesis --> Decreased inflammation, nociceptor sensitization, pain signaling

2. Acetaminophen --> Central COX Inhibition, possible COX-3 inhibition (splice variant of COX-1) --> Reduces Prostacyclin/Prostaglandin/Thromboxane Synthesis --> Decreased inflammation, nociceptor sensitization, pain signaling

3.a. Acetaminophen --> Metabolized to N-Arachidonoylphenolamine (AM404) --> Inhibition of reuptake of Anadamide (endogenous cannabinoid) --> Increased activation of CB1 receptors

3.b. Acetaminophen --> Metabolized to N-Arachidonoylphenolamine (AM404) --> Transient Receptor Potential Vanilloid (TRPV1) agonist --> active? at periaqueductal (central) gray --> opioid receptors that send descending axons to modulate pain at the level of the dorsal horn of the spinal cord

4. Acetaminophen --> Enhancement of serotonergic descending inhibition (5-HT pathways)

5. Caffeine --> Adenosine anatagonist (nonselective A1, A2A, A2B) --> Inhibition of vasodilation --> Cerebral vasoconstriction

6. Caffeine --> Analgesic Adjuvant --> Enhances availability of aspirin and acetaminophen.

# Thoughts

1. Selective: -COX, +CB1, +TRPV1, +Opioid, -Serotenergic, -Adenosine, -Inflammation, +Vasoconstriction/-Vasodilation

2. Aspirin doesn't work in isolation.

3. Tylenol-3 (acetaminophen) doesn't work in isolation (surprising!!!).

4. Headaches probably not -COX mechanisms

5. Caffeine is likely needed for -adenosine, vasculature effect implicating cerebral vasodilation

6. Densensitization strongly implicates +CB1/+TRPV1 as well as -adenosine, +Sero, +Opioid.

# Concluding Thoughts

0. Need to address MOH, this should be a conversatio with your real doctor.

1. Then for the headache, normal first-line would probably be a TCA prophylaxis such as amitriptyline with bonus target +sero/+opioid. Assuming you've tried this.

2. The failure of your other drugs means you should probably try CGRP Inhibitors to target vascular and pain-signaling effects. Maybe even gepants (acute)

3. Botox could be a consideration in a complex CDH case.

4. Zebras: Ditan/Lasmiditan. I assumed +vasoconstriction, but could be -vasoconstriction which is why non-combination drugs failed. Target 5-HT1F and avoid vasoconstriction for symptomatic relief, but doesn't treat underlying. Probably avoid due to MOH.

# Clarifying questions for your doctor, not me

1. Is your headache pulsatile/throbbing (migrane) or dull, tight, & persistent (tension-type)?

2. Onset characterized by stress (tension-type)?

3. Is it unilateral (migrane) or bilateral (tension-type)?

# What I would do next

1. Make an appointment with a neurologist

2. Before the appointment, make a detailed headache diary (when your headaches start/end, intensity of the pain, location and quality of the pain, associated symptoms (nausea, light senstivity), any potential triggers, what you did to try to relieve the headache and if it worked)

The deck used to just be shared on reddit & such. But for all your questions, there is now a central "upstream" entity called AnkiHub that organizes and maintains updates to cards, syncs, etc. It's a $5/month subscription, but a lot of my friends just subscribe for a month each year to get the updates then unsubscribe.

All cards start suspended by default, and you unsuspend cards usually by tag. For example, lets say you watched a a popular third-party exam prep video from Boards & Beyond on Insulin. You would find the corresponding video has its own tag "tag:#AK\_Step1\_v12::#B&B::08\_Endocrinology::03\_Pancreas::03\_Insulin" which you would unsuspend all the cards for. That's the basic flow, but everyone does things a little differently.

Some people don't watch videos just do review questions from UWorld which are also tagged. Some people manage cards using a mix of tags and decks. Some people search and manually unsuspend cards individually. Some schools cross-tag cards with their lecture. Personally, I use an AI search to unsuspend cards by cross-referencing against a PDF of lecture for the day.

Custom tags can be protected when syncing from upstream: https://community.ankihub.net/t/protecting-fields-and-tags/1...

https://bbc.co.uk sends me to https://bbc.com in the states and it is just infuriating

This is probably my biggest gripe. It’s so much information to digest at first, it’s a tough ask. And there’s so many rookie mistakes.

I made the mistake of just jumping in and I would say I spent the first 6 months using Anki “wrong” in the sense I would make bad cards, try to make mc questions, not enabling or optimizing FSRS, capping reviews, doing Anki before I knew the material, etc.

I’m someone who loves to learn from scratch/figure it out myself. I would never recommend watching a YouTube tutorial or following a guide for something you can figure out yourself, but I have to make an exception for Anki. Anki is one of those rare things where it’s simply just better to just copy what someone else is doing and figure out adjustments for your own workflow over time.

That’s because the default model is designed for the general user. If you sat down and really worked with the documentation, you would realize you shouldn’t be using decks or collections for management you should be using tags. Decks and collections are a different abstraction for different purposes.

I’m in medical school which has basically mastered Anki. The AnKing deck, used by over a million medical students, has over 35,000 cards, cross-tagged by numerous study resources that exists on a single “deck” which receives regular updates. I regularly run basically instant queries on over 40,000+ cards.

Medical school Anki has basically mastered this workflow and the original commenters complaints are completely wrong/come from a misunderstanding of Anki’s data model.

To be put simply, ignoring subdecks, filtered decks, cards vs notes, etc.: cards can only belong to one deck, but can have multiple tags. What exactly do you want to see differently in the data model?

It’s amazing how every single point you’ve made here is wrong as the other commenter already dove into. On top of that Anki is one of the best documented pieces of open-source software I’ve messed with. If you’re able to program, ChatGPT can basically handle any task you want it too, I data mine the sqllite database regularly for my own insights.

I’m my own villain

What’s with this rising trend of authoritative comments on HN thinking their individual rationale/experience generalizes. It wasn’t this bad just a few years ago, but now I’m seeing just outright absurd generalizations like this.

Why is it that apps in the US are not as (overtly) commercialized or gamified (like Temu) as some of their chinese-counterparts? Is american culture just less tolerant of it? You would think there is more profit to be made by doing so which would be very capitalistic in a sense.

Granted my response was a bit more hostile than the general tone of responses on this site. The person I was replying to had made a very large claim about passwords and general security that ran counter to what I think we can agree are generally well-understood principles of security and claimed he had philosophical reasons for doing so. The amount of confidence in his response rubbed me the wrong way and probably raised my own arrogance, sure.

> I don't think that closed networks substantially improve security and I don't like the push to require them.

You know what, you're right this is a philosophical stance, as dumb as a stance I might think it to be. My actual issue with his "philosophy" is that he makes a broad generalization when the statement really just applies to his unique use case. I didn't consider it to be a philosophical stance because I didn't think he seriously meant it as a systematic approach for the entire world but honestly re-reading what he wrote I think he does actually.

Honestly I take bigger issue with what he believes is a stance against opiniated technology but all technology is inherently opiniated his opinions are just different.

These are all practical reasons, not really philosophical. Unless any form of logic is philosophical but then everything is.

If your claiming your philosophical stance is setting passwords doesn’t provide security, by your own reasoning in your case that’s just a matter of practicality. There is no philosophical argument.

> More generally, I don't think that closed networks substantially improve security and I don't like the push to require them.

I mean that’s just your opinion, not a philosophical stance, and it happens to be a empirically demonstrably false one.

> I don't like technology that tries to enforce its own opinion about social norms.

This statement is so vague it’s practically useless. It can just be selectively applied against anything you don’t like. All technology is opinionated. From the layout of your keyboard to this site, everything is shaped by and shapes social norms. It would also be an opinionated technology if it decided not to ask you to set a password by default. You might as well have said I don’t like WiFi passwords because I don’t like WiFi passwords and it would’ve carried the exact same message.

Gratuitously, maybe he has a device that can’t connect to WiFi network with a password. Realistically, probably just laziness. Neither of these are philosophical though…

What you’re describing is just human nature. I also wish for a world where everyone was honest with their intentions. It’s not realistic. You might as well just complain about humanity as a whole, unless you have a better idea, or can fix humanity, dating apps do a decent job.