Give a man a fish and he'll eat for a day. Take a fish from him at gunpoint and tell him he's just lucky you let him live, and he'll find a way to catch another fish for you to take tomorrow.
Indeed, apparently I still know how to play trombone even though I didn't play for 15 years between when I quit in grad school and when my kids needed help learning their parts for a concert.
My son is a very serious-minded chess player -- much better than I ever was -- and he actually got me to sign up for a tournament this weekend. I am 40 years removed from my last tournament-style chess experience, and I was ... not so good. But over the course of five games, I got better, and it was fun! I think I'll do it again.
I remember learning some useful things about how to swim from watching Sally's lessons/swim-team, and I was starting from a baseline of being a perfectly adequate swimmer.
I'm encouraged. Haven't touched my trumpet or practiced martial arts in almost 20 years. Nice to know I might not have completely forgotten that stuff. I can't imagine when it would be useful (the trumpet, quite possibly never; the martial arts, maybe if I get mugged, but chances are slim that something that looks exciting would help), but you never know.
I noticed something similar about speaking French, when I was there in 2017. I had spoken French pretty much fluently after my year as an exchange student between high school and college and then used the language very little after college. My previous three trips to France, I was just there as a tourist with Cassandane and/or family, so I'd have limited interactions with French people. I'd order drinks or try to check in at the hotel in French, the waiter or clerk would respond in English, I'd feel discouraged even though I knew it didn't actually mean my French was bad. But in 2017 we were traveling with Atossa too, and stayed with my aunt part of the time, who was living in a house she'd rented for a year. It turns out that those activities stretch your vocabulary, and I did better than I expected.
If you're about to get mugged, ask them to be polite and give you a few minutes to practice and refresh your skills first.
i'll still bust out the obscure fr vocab knowledge to the benefit of the young one, even on the eve of bacc madness. i've been spending lots of quality time with marcel p., which among other things is a bad influence bc encourages the dropping of random english words and phrases into one's french in emulation of odette's hilariously not-chic chicness. also is there anything more amazing than the princesse des laumes when she's being passive aggressive??? it's like a shimmering torrent of conditionals repelling disagreeable and/or undesirable relations. marvelous.
also is there anything more amazing than the princesse des laumes when she's being passive aggressive???
I know! The Baron Charlus going to great lengths to show how totally not-gay he is.
I still remember how the chess pieces move.
I still remember part of a verse from Isaiah in Hebrew (the book of the Bible that we studied in 8th grade, the year I was in Israel). ("Children I have raised and they have risen up against me (peep's translation)
I still remember one verse of a poem by Victor Hugo that we had to memorize in French class "A quoi bon entendre les oiseaux de bois...." (I looked it up and I remembered it slightly wrong)
I think that's all.
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The child psychiatrist we're working with is being vague about something where I'd like firm details.
Pokey is on a medication. We started at 2 mg at night under our pediatrician, and there were still problems. Moving to child psychiatrist, she says to try taking 2 mg in the morning, instead. We saw dramatic improvement. After 5 days we saw some side effects: significant drowsiness in the evening.
Psychiatrist recommends trying 1 mg in the morning. We do, and it's a disaster. So we're back at 2 mg/morning, and not yet far enough to see side effects yet.
Twice, in different ways, I've asked, "if we're experimenting with doses and timing to find a balance between effect and side-effects, would it be safe to try 1 mg in the morning and 1 mg at night? My blind-guess thinking goes that that would level out to 1.5 mg in his system for most of the day."
Her answer both times has been, "The Extended-Release is typically dosed just once per day. Let's stay where you are for the time being with medications and see how he does. Remember, you can move the ER to bedtime if drowsiness persists during the day."
Right...but is it safe? I mean, if we're titrating between 2 mg at night (insufficient) and 2 mg during the day (side effects), it seems like a really reasonable thing to try.
Yeah, yeah, my child's brain. I won't experiment unless I've got a clear statement of safety.
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AFAIK most psychoactives take ~2 weeks to level out. How long did you have him on 2mg in the morning?
Also, the the levels of the neurotransmitters I assume are being manipulated vary naturally during the day, so constant dosage isn't necessarily the target.
8: yes! the whole cast regularly delightful, particularly the pre-dawn orbiting furniture is an especial favorite of mine in the category of very satisfying multi-voice bits like in mozart's operas. yum.
10: that sounds like an alarmingly low-content interaction with the dr., do you think it might be fruitful to tackle that issue head on? "we asked x, you answered as if we'd asked a, we had the impression that either you had not understood our question or that you are responding with a script not responsive to x. allow us to be perfectly clear that we are asking x not a, and also that we need for you to affirmatively state that you are not responding by script. then answer x." an answer to x can include the previous script only if dr can explain why it answers x.
also, consider canning this doctor, but i have a short fuse for drs who cannot be bothered to communicate clearly. i'm expected to do so in day-to-day working life, no reason they shouldn't be expected to do so as well. it particularly pisses me off when i strongly suspect that other patients are never going to get the kind of interaction i can extract by calmly and patiently insisting on it.
Op.last: I know what you mean, but I don't know that this is an intelligence thing. I have failed conversations in Chinese in my head all the time! I don't know how my imaginary interlocutor speaks better Chinese than I do, but he does.
AFAIK most psychoactives take ~2 weeks to level out. How long did you have him on 2mg in the morning?
About 5 days, last time. He's on the third day this time around.
also, consider canning this doctor, but i have a short fuse for drs who cannot be bothered to communicate clearly.
I suspect she just doesn't have a better answer here for me. She's actually been great in lots of ways. She is doing all this over email, between appointments, and is writing otherwise-thoughtful responses to help us tweak the doses, etc.
16: She should be able to get to "I know that splitting the dose is unsafe, we can't do it"; "Splitting the dose is safe, and we can try it if you think it might work"; or "I don't know if it's safe and I'm not comfortable trying it." Maybe the answer is the last of those three, but she's not willing to say "I don't know"?
Surely splitting the dose can't be more unsafe than just having 2mg. I'm a little skeptical of your "similar to 1.5mg" calculation though, it sounds like the doctor is saying that it's a 24-hour release and not 12-hour release. But either way, I can't come up with any reasonable model for release rates where you'd end up with more in the blood stream at any given time for 1mg twice a day compared to 2mg once a day.
The only way I could see it being a problem is if for some reason it's important to have none in your bloodstream for some amount of time every day. Like say it blocks something from working but that thing only needs to work for like 6 hours a day. That seems pretty implausible.
But I guess I understand the dilemma the doctor is having. Surely it's never been *tested* for safety at 1mg twice a day, because that's not how it's designed to be used. So the doctor can't really tell you definitively whether it's safe or not.
If you mean splitting the dose by cutting an extended release 2mg in two pieces, that's not a good idea. ER tablets are formulated to release at a certain rate, cutting them can change the rate at which it dissolves or otherwise controls the dose. If you instead wanted to get two 1mg tablets with a 12hr formulation that might work.
I'm not going to make a recommendation since I'm not an MD and I don't even know what drug you're talking about but the important parameters in drug exposure are maximum blood concentration (Cmax), time above a certain threshold, and total exposure (integral under the exposure curve, AUC). ER tablets are designed to make it more convenient to take a dose less frequently without a spike in Cmax leading to side effects while keeping the exposure above a threshold for a longer period. I believe in most psychiatric medications the threshold is the important thing. You could probably get the regular pills and then play with the timing if you have the ability to make sure he's taking it on a fixed schedule, but that's often hard with kids which is why ER is supposed to be more convenient.
Love for 20. Extended release formulations are notoriously not recommended for splitting. And yeah, I bet there is some optimal dosing but it might take some unfortunate trial and error to figure out.
The current dose is 1mg per day, so surely that's a 1mg individual dose and no one is suggesting actually splitting a pill.
(Puts pill cutter behind his back and walks away from the already-addressed envelope)
Right. Nobody was suggesting that.
It sounds like the 1mg is also 24 hr release which is why doctor said not to do two 1mg per day. I'm actually not sure what the exposure curves would look like there- heebie's estimate of 1.5 might be right. But if there's a 12 hour 1mg that would be a different shape.
The hardest part with 24 hr release pills is finding the 23 hr version you need for the Sunday when we start Daylight Savings.
But basically any shape you're going to have less exposure from two 1mg taken 12 hours apart than from one 2mg taken once per 24 hours.
I bet if my parents had made me practice cheese for 30 minutes every day, I'd be a genius at cheese.
Maybe cheese wasn't seen as appropriate for children during the 70s, because associations with things like fondue.
22 and 24 are right - we have 1 mg ER pills. I know you're not supposed to split ER pills.
But basically any shape you're going to have less exposure from two 1mg taken 12 hours apart than from one 2mg taken once per 24 hours.
Right. And since we'd like to split hairs between 2 at night and 2 in the morning, it'd be nice to know if this extremely easy experiment is at least safe.
The medicine is Guanfacine, fwiw. One problem is that it's a low blood pressure medicine, so you can't abruptly start and stop it. You have to step down by 1 mg for a few days. So it stands to reason that switching from 2 mg at a dose to a 1 mg/2x day is totally fine. But when she has us switching from 2 mg at night to 2 mg in the morning, or vice versa, it gets tricky because he's going 36 hours without any dose.
At any rate SP and I are just role-playing you and your doctor and not really adding much. Your doctor doesn't know what measurement is the important one for risk here, and doesn't know what the exact release curve is, and it's never been tested at 12 hours apart, so they can't say for sure that it's safe. Even though if you think about it it almost certainly has to be, but that's not how doctors are trained to behave. (And for good reason! They can't all be experts on everything and if they rely on their back-of-the-envelope calculations all the time, things are going to go badly wrong occasionally.)
That said, is the 2mg dosage just taking two 1mgs or is it a separate pill? In the latter case I almost think there's a theorem saying 12 hours apart can't be worse... In the former case one can imagine things like the 2mg having more frequent timed releases and the 1mg having less frequent timed releases, so if the timing conspired against you completely you could get short bursts that were worse with two 1mg than a single 2mg.
We actually have both forms from various rxs, and have been explicitly told that taking two 1 mgs or one 2 mg is interchangeable.
(By latter I meant former. If you're taking two pills I think it's easy to see that for any reasonable shape, and maybe actually any shape, the worst case scenario is taking them both together and so 12-hours apart has to be safe. If you're comparing one pill to two pills then maybe something weirder could happen.)
We used to wrap pills in cheese to get the dog to eat them.
Given 32, I think there really might be a theorem here... Something like for any (smooth? measurable?) release curve f on the circle, any measurement of risk r with certain mild properties (invariant under time shifting, maybe a little more?), and any offset a that r(f) >= r(1/2 f(x) + 1/2 f(x+a)). But I'm not sure yet on the details.
Don't you have like four controls?
If r is convex (that is r(a f+ b g) \leq a r(f) + b r(g) for any two positive numbers a,b with a+b=1) and invariant under time shift, then the conclusion follows immediately. I'm pretty sure that any real-life risk function is convex, but I'm not sure if there's a weaker assumption you can get by with.
You can drop time invariance (while keeping convexity) if you know that taking two pills at the same time is safe *at any time of day*. Which you can be pretty confident on since you know morning is fine and night is fine.
I don't especially want to overhear heebie making that argument to the doctor, but I would like to hear the doctor describing the conversation later.
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Due to their low prices, investors have long characterized these shares as "eggs and dumplings," and the new rule would remove such nonviable securities from the local bourseI mean, I like eggs and dumplings.|>
35: Like SP said, pharmaceutical effects (and side effects) have various drivers. Some are driven by time above a given concentration in blood (lots of antibiotics are like this), some are driven by integrating the area under a concentration curve, and some are driven by the maximum concentration in blood. Dosing twice a day would give a longer period of a higher concentration and less trough. This might increase efficacy but also presents a higher risk of side effects. You're correct that a twice a day dosing regimen should not at any time give a higher peak concentration than once a day, but you don't know what parameter is the key one. Lots of optimization goes into those dosing schedules. Medical doctors are by nature fairly conservative when there's no evidence that altering a validated dosing schedule would still work without increasing risk.
Maximum concentration and anything along the lines of integrating area are convex.
Time above threshold is not convex. This is like my comment above that if what you need is a certain amount of time with no drug that's different. But if time above threshold is the problem, it seems like taking two time release pills is already pretty unsafe. If the timing is a little off between the two pills then you end up with way more time over the threshold. But I do agree you can construct a corner case where the release curve is very discrete and highly spaced out and time above threshold is what matters.
Heebie, maybe you could consult with a pharmacist (or suggest that to your doctor)? Pharmacists are specifically trained to know about dosing schedules, how safe it is to change them & etc. Physicians not so much.
Or, maybe you could try what the qualified child psychiatrist says and see if works.
Furthermore! The pediatrician originally gave us a bunch of 1 mg pills and told us to spend 1 week at 1 mg, and then step it up if we didnt see an effect, and then we could step it up to 3 mg if we still didn't see an effect. I forgot about that, because we switched to the psychiatrist along the way. So we do have a doctor telling us it was fine to go up to 3 mg on our own judgment.
On a schedule of your own choosing.
The pediatrician had us taking them at bedtime (because of the possibility of drowsiness).
42 and 43: my hospital has a program where primary care doctors can electronically consult specialists with discrete questions for advice without making the patient see a specialist. One of these electronic consults allows s doctor to consult a pharmacist for advice with dosing medications.
eConsults! Very popular in some circles. (Replacing the old "curbside consult" where a PCP finds some random opportunity to buttonhole a specialist)
Can I just say how incredibly thrilled I am that the FDA approved Esketamine! I still have to see which offices will be approved to dispense, and whether it's covered by insurance, but I've been waiting on this for YEARS!
Ketamine! Woohoo!
Also: any recommendations for stuff to do in the New York State (ie not city) area? Niagara Falls and Ft. Ticonderoga already on the list, thanks. Not confined to NY state either but that general region would be good.
Anything particular you're interested in, or parts of the state you're likely to be in? It's a big place. E.g., if you were going to be around the Hudson valley south of Albany, I'd send you to Olana -- a house museum of one of the Hudson Valley School painters. The house is amazing, the grounds are lovely, it's a terrific afternoon. But you could be eight hours away from there and still in NY.
If you're near Corning at the other side of the state , the Corning Glass Museum is surprisingly worth a stop. Anything wilderness-y, you want Adirondack State Park, and if you search for lodges in the park there are still a bunch of places that are leftover luxury resorts from the late 19th/early 20th century -- the sort of place Teddy Roosevelt would have hung out.
You should walk from Nothville to Lake Placid.
But honestly, NY state is bigger than England. So it's hard to make suggestions without some more specifics.
This is long-distance planning for June; the Selkie and I will be on holiday, starting and finishing in NYC but with just over a week to travel around the area. Niagara Falls and Ft. Ticonderoga are both of interest so other stuff in the northern part of the state would be best. Hydro-electric power stations, civil defence bunkers and museums of obsolete technology have previously gone down very well with her, so if there's anything along those lines that would be great.
Buying cheap cigarettes to bring to NYC seemed popular when I was there.
Adirondack State Park looks just right - thanks!
Seconding Olana, some great Moorish Revival architecture.
I'll be in NYC area for all of June but it looks like ajay is doing his best to keep the Selkie away from us reprobates.
The Adirondacks are great. Check out Lake George. And Saratoga Springs is pretty nice.
If you'll be in the city, Olana is close enough to fit it in, and it's really terrific. Also, if you somehow end up in Albany (but why?), an architectural tour of the state capitol is worth it if you enjoy frankly demented public architecture.
Something I haven't done but keep meaning to is biking the Erie Canal, which is a trail now, and Buffalo (near Niagara) is one end of it. If that appealed, you could look for an organized tour or a bike rental place in Buffalo to do part of it.
Adirondack State Park seems kind of open-ended.
I'm not much of a wilderness person myself, but I do work in the Woodland Creatures Legal Defense Bureau, so most of my coworkers are hiking nerds. If while you're planning, you have particular questions about something to do with the Adirondacks, I can find out from people with personal knowledge.
64 was intended as a horrible pun only.
Anyway, it's the Northville-Placid Trail. It's 133 miles, so wear comfortable shoes.
Also, remember that bears in the Adirondacks can open the clear-sided kinds of bear cans.
museums of obsolete technology
That's kind of what Lake Placid is, if sporting technology counts.
I've been chased out of my campsite by bears in the Catskills. (Story told here multiple times here I'm sure -- searching cubs, babka should find it.)
I didn't go when I was last upstate, but this looks like it might be up your alley.
I doubt there's any way to get chased out of there by a bear.
71: That's a good story! I found 2 versions.
I've never seen a bear in the wild, except in Yellowstone at what must have been several thousand feet away.
Are there wild bears in Wales? If not, is there a charity trying to establish them in Wales?
When I was a kid I thought Wales comprised villages built on the backs of whales. I'd donate toward that cause.
It just seems to me that Scotland doesn't have enough trees for a happy bear population. Yorkshire maybe.
If Spain can have bears, I don't see why Wales can't.
But if it doesn't have any now, the bears will have to travel long distances to shit.
Pine trees grow like weeds, apparently.
So, there's a cow moose and calf running around downtown this morning. This is pretty unusual here.
The waterfront in Buffalo is nice for walking around, taking a pedal boat out, that sort of thing, plus has plenty of visible urban decay. I think there are better options if you don't have three small children with you, but I wasn't paying attention. If you're crossing to Canada to see the better falls, Old Fort Erie is nearby and kind of interesting.
We drove right through Buffalo without stopping because it never occurred to us that there might be something to do in Buffalo.
That is, there's no better city to do it in. Although I suppose ideally you'd just watch them do it to each other.
It's more fun to watch them in the pedal boats, but only Buffalo with money can rent those.
When I was a kid I thought Wales comprised villages built on the backs of whales.
I am working on the fourth in a series of short SF stories based on pretty much this concept only bigger.
All: thanks very much for all the suggestions! All look hopeful. We'll sit down this weekend and work out what we can fit in. Possibly even including Fresh Salt.
I do work in the Woodland Creatures Legal Defense Bureau
This is the second-best sounding organisation ever, following only the Ancient Tree Forum which I am pretty sure is just a rebranded Entmoot.
"In the Hundred Acre Wood the woodland creatures are represented by two separate but equally important groups: Rabbit's Friends and Relations, who investigate Woozles and Heffalumps, and the Woodland Creatures Legal Defense Bureau who prosecute them. These are their stories."
That is, sadly, not our real name, which is much blander. And we're actually on both sides of the woodland creatures thing -- a woman two doors down from me spent a couple of years in court trying to kill someone's pet deer, which was a little grim.
Was it grim before they started trying to kill it?
That court must have smelled terrible by the end.
Someone really should have told her to use a sharper knife.
I assume if Niagara Falls is on the list and hydroelectric power stations are of interest, the Robert Moses Niagara Power Plant is already under consideration?
I sometimes wonder if somebody isn't feeding the small, local deer herd that sometimes shits on my patio.
96: is there another reason to go to Niagara Falls?
Heebie's colleague can help you out. Eventually.
There's a small, old, apparently defunct hydroelectric station on the Canadian side of the falls, if your visa allows reentry.
The Ithaca area has a lot of stunning naturey stuff and is otherwise a fun little hippie town. I can't think of any obsolete technology stuff in particular but I wouldn't be surprised if Cornell has some old nuclear/particle physics (I think they had one of the first cyclotrons) or computer science things on display somewhere. And it gets you closeish to the aforementioned Corning Glass Museum. (And the entirely unremarkable small town John D. Rockefeller was born and raised in, if that scratches a history-loving itch.) There are also a bunch of wineries in the area; the Fingers Lakes have some weird microclimate stuff going on.
You can also come over the border to northern Pennsylvania, but almost anything you'd find there you'll find more interesting comparables in Upstate New York. I guess if you're out west you could check out Oil City, to see remnants of when the oil industry was a tiny thing with a startup culture. Going the other way, I bet you could find some cool historic stuff in Western Massachusetts--apparently the Springfield Armory does tours.
I guess if you're out west you could check out Oil City, to see remnants of when the oil industry was a tiny thing with a startup culture.
I have an ex-uncle-in-law who managed a farm in central Pennsylvania (western? Not far from Punxsutawney) with a working oil well on it. Little thing. I think every week or two a truck would come by and pick up a barrel or two of crude, although I was never clear on exactly how it worked.
98: Sure, the Nikola Tesla statue.
I wouldn't be surprised if Cornell has some old nuclear/particle physics (I think they had one of the first cyclotrons) or computer science things on display somewhere.
Not AFAIK, though the campus itself is pretty cool and worth visiting if you're in the area. I haven't been back in a long time though so I can't think of any specific things to check out. I'll think about it.
I went to a wedding on the campus. There was a nice little chapel.
105: It really is great. Lots of interesting architecture, especially collegiate gothic, but that's probably less interesting to a Brit. Oh, and the great art museum, which was designed by I. M. Pei.
Oh yeah: if you want weird history stuff between NYC and Niagara Falls, you might want to consider the Hill of Cumorah. I think it's right off I-90.
If you take the Taconic Parkway north there is a pretty good diner near the top.
museums of obsolete technology
They still run a company out of Armonk, NY?
If Led Zeppelin never existed, Thor Ragnarok would have been a worse movie.
So much eye liner. She must be evil and powerful.
Jeff Goldblume was really not expected.
He's very good about sending in the RSVP card to invitations.
He was born just across the river.
You have so many of those, status consciousness must be tiring.
My band toured through Buffalo, maybe ten years ago. It was a Monday, and the bar we played at was totally dead. But the staff took pity on us, and after the show they took us out on the town. Eventually we ended up at a big dive bar whose Monday-night special was something like "Porn 'n' Chicken:" 1970s adult films playing on all the TVs in the bar, and you got a piece of grilled chicken with every drink you ordered.
So I recommend avoiding Buffalo. But Niagara Falls was awesome.
Usually you leave the grammar pedantry to me.
I mean, I'll eat the grilled. But if there's an option.
Buffalo is kind of famous for a deep fried chicken dish.
Why do they call it Buffalo anyway.
Grilled chicken?
Cooked on a grill and slathered with barbecue sauce.