Untitled

[world-beauty]

The Tulip in the Swan

Credits: Martin Pugh

[creekfiend]

i will also say that your doctor should absolutely tell you about possible side effects and interactions of medications they're prescribing to you! and also, pharmacies are obligated to provide you with this literature upon request, if they don't already give it to you with the medication itself. its always a good idea to ask for that literature when picking up a new med, and to read it through really thoroughly! that of course won't give you the kind of information like individual people sharing their experiences here will give you, but it is a good starting point for any medication. if you look at the wikipedia page for the medication you will also find information like the mechanism of action (if known,) the class the drug is in (which will give you information about things like abilify being an atypical antipsychotic,) and the half-life of the drug in your system. you can find out what waste filtration system the med is filtered thru (kidneys or liver*) and also stuff about crossing the blood-brain barrier, both of which are also REALLY useful things to know

these are all really good and important things to be aware of and I recommend gathering that info for any new meds. i don't say this to like, blame people who were not given this info by their doctors and who took meds without being given this information, but rather to give people resources for being more in control of their own medical treatment going forward 💜

*this was really crucial to know when my dad was dying bc his kidneys were overtaxed by all the medication that was being thrown at them and we ended up having to mess with the timing of his pain medication pretty carefully to avoid the meds building up in his system. each individual med wasn't the issue, it was the NUMBER of medications that the kidneys were being expected to handle -- in his case, ibuprofen was one of them; over the counter meds absolutely count towards this lol. knowing which OTC meds are filtered by the liver (acetaminophen) and which by the kidneys (ibuprofen) can really help you when calculating how much of each kind is safe to have at the same time.

[ymirjotunn]

hey! now that i'm on desktop, i wanted to add information about something i think should honestly be required to explain to "polypharmacy patients" (anyone who's taking multiple medications): cytochrome p450, or CYP450 for short.

CYP450 is a family of enzymes in humans. enzymes are chemicals that speed up chemical reactions; in this case, in our bodies, CYP450 enzymes process the vast majority of currently available medications. because of that, they're responsible for most drug interactions.

different substances - including medications, supplements, and even foods - can affect the CYP enzymes in different ways.

a CYP inhibitor blocks the CYP enzymes from working to process the medication. that means you can end up with more of the medication in your body than you expect. that can cause mild, moderate, or severe side effects. good examples of CYP inhibitors are St. John's wort, grapefruit, and isoniazid (a tuberculosis medication).

a CYP inducer encourages the CYP enzymes to work faster. that means you can end up with less of the medication in your body than you expect. that medication may not work as well. this can be especially dangerous in cases where, for example, you're suppressing a dangerous effect (like autoimmunity or transplant rejection). some examples of CYP inducers are insulin, tobacco, prednisone, and in some cases, St. John's wort again.

a CYP substrate is just a substance/medication that is affected by an inhibitor or inducer. birth control is a very common substrate, and its effectiveness is affected by many medications.

each substrate is related to a different family of CYP enzymes, like CYP3A4 or CYP2D6. each one responds to different inhibitors and inducers.

you can see why they often don't tell patients this stuff: It is complicated. this is pharmacokinetics! it's difficult stuff. but i really, really believe it's important. knowing how your medications affect each other can save your life. doctors and pharmacists often do not check medication interactions. sometimes it really is up to us to understand what we're putting in our bodies.

at the very least, i urge you to check drug interactions with the drugs.com interaction checker. this checker automates some of the work of cross-referencing CYP relationships. if you have an account, you can save your drug list and cross-check all of your meds at the same time. keep in mind that not all "severe" interactions will necessarily apply to you; i recommend reading the "for professionals" version of the warning to make informed decisions about whether or not you want to be concerned. (this is also something you can discuss with a good doctor if you have the good fortune to have one.)

but, if you have the capacity, at a certain number of medications (i am taking 20+) it really is worth getting to know how they interact with CYP enzymes, what effects you might need to be watching out for (more intense effects from a higher concentration of medication? less intense effects as the medication can't attain high enough concentrations to work as it normally does?), and what meds might be the culprits of new problems as you add more medications.

to cross-check CYP relationships directly, i recommend the flockhart table. search for a medication (ctrl+f helps) and you can see all its documented CYP relationships. (they also have a mobile friendly version, but i find it slightly harder to interpret.)

here's how i do it.

start with a medication or substance. let's say i'm about to start celecoxib (Celebrex), a non-steroidal anti-inflammatory drug (NSAID). on the flockhart table, it's listed as an inhibitor of CYP2D6. (ctrl+f is helpful here.)

think through what the words mean. it's an inhibitor, so it makes the enzymes not work as well. it might increase blood levels of medications that are processed by CYP2D6.

what medications are processed with that enzyme? the flockhart table lists them if you click on the name of the medication you're curious about. CYP2D6 substrates include amitriptyline (Elavil), aripiprazole (Abilify), atomoxetine (Strattera), duloxetine (Cymbalta), oxycodone (Oxycontin), and propranolol, among others.

what effects do i need to be watching for based on the affected medications? for an inhibitor, we're looking for stronger effects; for an inducer, we're looking for weaker effects. let's say i take oxycodone daily. i want to keep an eye on the way i feel when i take oxycodone. am i feeling "higher" than usual? am i feeling dazed or dizzy or numb? or let's say i take propranolol. am i feeling dizzier or more lightheaded? am i having nightmares that i wasn't before?

here's another example. what if i want to check for a substance that might not be listed on the flockhart table? grapefruit is a good example.

wikipedia is actually a great source for this (though in some cases i recommend just searching "[substance] CYP" and seeing what pops up).

head to the list of CYP450 modulators on wikipedia. ctrl+f finds three instances of grapefruit: naringenin (a CYP1A1 inhibitor), generic 'flavonoids' (inhibiting CYP2A6), and bergamottin (a powerful CYP3A4 inhibitor).

think through what the words mean. any substrate medications processed by 1A1, 2A6, or 3A4 enzymes might be dangerously increased in my bloodstream if i consume grapefruit (or anything containing those substances; earl grey tea actually contains bergamottin, too!)

what medications are processed with those enzymes? this i can check on the flockhart table, or i can stay on wikipedia. atorvastatin - a cholesterol medication - is a substrate of 3A4. so is diazepam (Valium). valproic acid, an anti-seizure medication, is a substrate of 2A6. i'm having more trouble finding substrates of 1A1. it's not listed on the flockhart table. there is a paper published that mentions theophylline (an asthma medication) and difloxacine (a fluoroquinolone antibiotic).

what effects do i need to be watching for based on the affected medications? at a glance here, i'd be worried about having too much valium or valproic acid in my system (if i took those meds) - those could have pretty serious effects on my central nervous system. likewise, having too much of that fluoroquinolone antibiotic (if i took it - and i wouldn't, because if you have hEDS you should not take fluoroquinolones unless it's a matter of life or death!) could increase my risk for serious musculoskeletal side effects like tendon rupture. it could also disrupt my bacterial microbiome.

the physician who created the flockhart table, the late dr. david flockhart, was an exemplary physician who truly, truly cared about patients - a rare treasure. everyone's CYP-related genes are different, and it affects the way we respond to medication. we know that, just as we know that CYP relationships can cause serious and harmful drug interactions. but we don't put it into clinical practice. dr. flockhart wanted to change that, and he did pave the way towards that future. we're not there yet. but i do recommend his table.

i hate that this is not something that is widely taught and widely understood. i hate that we have this knowledge about how people metabolize drugs and how drugs work with each other and we often just do not talk about it at all. i hate that i was not instructed on the risks of taking clonazepam (a benzodiazepine, in the same class as Valium) and hydrocodone (Vicodin, an opioid) simultaneously. i experienced central nervous system depression - difficulty breathing, dizziness, confusion, fatigue - multiple times as a teenager before i figured out that i shouldn't take them close together. needless to say, mixing those two drug classes can be extremely dangerous. i got lucky and just felt awful. but at certain doses or under certain circumstances, taking those two simultaneously could kill someone. Does kill people, in fact!

a responsible doctor - one of my favorite doctors! - prescribed me those medications. he just wasn't thinking. it happens all the time.

we should not have to be doing all this work. but often doctors and pharmacists simply do not think about it. and the literature they hand out with medications, while helpful, is not going to cover all possible interactions, especially for polypharmacy patients or people on unusual medications.

likewise, you should know what medications interact with your conditions - like i mentioned fluoroquinolones and hEDS earlier. or how morphine tends to activate mast cells. that's something i can't cover here, though.

i know this is a lot, and i know not everyone has had the opportunity to acquire medical literacy skills so they can interpret all of this information. my inbox is always open to medical questions (i am not a doctor + i do not know your medical history but i can provide explanations and sources and explain jargon) if you are trying to figure something out and just can't. i hope that this explanation helps someone to better understand what is going on in their body, or to make informed decisions about starting or stopping a medication.

[creekfiend]

this is so so helpfully written and such a great resource, thank you so much for adding it!

[himekokosu]

Roses

[rosieandthemoon]

The garden at Edgemont in Albemarle County, Virginia {via}

[tarrigon2]

Flowers I saw on a walk

[tarrigon2]

A sunrises and sunsets I was able to take photos of

[pnw-forest-side]

Gatton Creek trail - near Lake Quinault

[icantspellthings]

Top 3 things people love insisting they don't have despite it being impossible

Pronouns

An accent

Bias

[icantspellthings]

Im going to shoot you people with a fucking gun

[televisionenjoyer]

Everyone has an accent it came free with your language 🙄

[audliminal]

Congrats to every reply like this for failing to understand the fundamental definition of an accent. Of course you think you sound normal! It's the way you speak!

[salarta]

Gonna sign language at you in a very southern accent

[inthewaytoamultilinguallife]

Sign languages also comes with accents, you can easily watch people sign and tell the difference

You get different sign language accents, you get regional accents, and you even get "second language speaker accent"

[seabeck]

Meadow

[rosieandthemoon]

Tararua Forest, New Zealand

[himekokosu]

Viola

[hacvek]

reminder to worldbuilders: don't get caught up in things that aren't important to the story you're writing, like plot and characters! instead, try to focus on what readers actually care about: detailed plate tectonics

[olyia-stories]

@dragonpyre any chance you could elaborate on this

[dragonpyre]

I grew up learning about land formations. Seeing fictional maps that don’t follow the logic and science of them makes me upset

[serinos-kitt]

What are the most common sins you’ve seen relating to this? I wanna know

[dragonpyre]

Mordor.

Why is the mountain range square. How did the mountain range form. Why is there one singular volcano in the center. Why does it act like a composite volcano but have magma that acts like it’s from a shield. If it’s hotspot based volcanic activity why is there only one volcano.

And then the misty mountains!!!! Why isn’t there a rain shadow!! And why is there a FOREST where the rain shadow should be!!!!!!!!

[serinos-kitt]

So what is a rain shadow?

[lethalbutterfly]

Wind blows clouds in from the sea, but mountains are so tall the clouds can't get past 'em, so you get deserts on the windward side of mountain ranges because clouds can't get there to water the land, or do so only very rarely.

[roach-works]

this is because, as clouds are forced upwards by rising land, they cool and dump their rain. so the side of the mountain facing the ocean (or an inland sea, or a great lake) gets all the rain as the clouds are squeezed out, and the opposite side gets nothing.

my favorite thing is the american great lake snowbelts! so, the 'flow' of weather across north america, in very general terms, blows from the northwest on down south and east to the gulf of mexico.

so the wind is blowing from west to east, and in the winter it's a dryer wind than in the summer because it's colder. but after blowing across a great lake for a hundred miles, the wind is wet again. and that wet turns into snow. so for all of these lakes, the big cities are on the west side, not the east sides, because the east sides absolutely suck to live on.

the sole exception is buffalo, NY, which literally has to be there because, unfortunately, that's where all the important canal stuff between lake ontario and lake erie is happening.

also this always strikes me as cool, check out where cleveland is:

it's right at the edge of that snowbelt. and you see way more cities west of it than east, too.

[beatrice-otter]

#but again. mordor looks like that becaue sauron made it#and he's an ass

On a Watsonian level, sure.

On a Doylistic level, Mordor looks like that because plate tectonics was a fringe, ludicrous, laughable theory that nobody outside serious geology nerds had ever heard of until scientists proved seafloor spreading in the early 1960s. The first edition of the LotR trilogy was published in 54-55. We literally did not know that plate tectonics was real until almost a decade after the book was published, so obviously, it was not something Tolkien could have been considering as he made his maps.

I don't know enough meteorological history to know when white people figured out about rain shadows and added it to geology classes, or what would have been taught about volcanoes and such. But any education Tolkien got on the subject would have been in childhood/adolescence; his college education focused on the liberal arts, not the sciences, and his professional study was linguistics and the middle ages. So anything Medieval and earlier European authors wrote about he had a pretty good chance of knowing about. But not much exposure to modern science. So his science knowledge was probably limited to "what English schools taught at the turn of the 20th Century."

[whetstonefires]

I mean, it's true he didn't know about plate tectonics, but he did know what mountains look like, and that it's not normally That. And it wasn't his style to break that kind of norm without cause.

LotR has recurring themes of the reckless imposition of one's will on the natural world creating ugliness, an order you thought was inherently an improvement that in fact is inferior to what you have displaced. (Typified by reckless tree-felling; a reflection of the despoiling of the English countryside and the world by Progress.)

Mordor is a rectangle because Sauron is an asshole.

[beatrice-otter]

#the rain shadow thing otoh was undoubtedly total ignorance#but those mountains were made as the fortress of a demigod#too steeped in evil to understand beauty#it's *supposed* to look like something that Shouldn't Exist#like quite often this is something that happens in worldbuilding yes#things are arranged Wrong because a person doesn't grasp the underlying logic#but mordor is a bad example for the same reason it's an obvious one#it's So Very Wrong because it was designed to be wrong#to give you a bad feeling with how much it shouldn't look like that#if he just wanted it unapproachable on all sides it could've been in a caldera formation it didn't *need* corners#the corners were a choice#tolkien's job involved lots of looking at maps and things okay#meanwhile people whose lives revolved around the weather generally knew where the rain happened#long before it was formalized into 'rain shadow effect'#people not having The Science doesn't mean they don't have eyes and brains

[cannibalcharon]

Western Washington vs Eastern Washington is a good example of a rain shadows effects for fellow writers.

Western Washington:

Eastern Washington:

For fantasy writers, Washington is a really cool state to study because we have nearly every biome from alpine forests, desert, alpine desert, rainforest, riparian forests, wetlands, coastal, and so on. We have two main mountain ranges, the Olympics and the Cascades. We sit on three tectonic plates which give us said mountains (and earthquakes). Our ecology is really neat here.

[the-wolf-and-moon]

PK 164 +31.1, Dragon Eye

[spacewonder19]

The Cave Nebula: Star formation © chucksastrophoto1

[expressions-of-nature]

Atera Valley, Japan by Ron

[world-beauty]

A Superwind from the Cigar Galaxy

Credits: FOCAS, Subaru 8.2-m Telescope, NAOJ

[jeannepompadour]

Marble bust of Marie d’Anjou, Queen of France, circa 1465

[sartorialadventure]

The wimple - the head veil with the chin covering - was traditional in the Middle Ages for married women. Just like women in Islam today, in certain periods married Christian women were required for religious and modesty reasons to cover their hair.

The cloth that covers the chin was called a barbette, and had the extra benefit of hiding a sagging neck!

I call it a barbette because it appears to be a strip of cloth unconnected to the cloth on the shoulders and chest. If it were all one piece of cloth, it would be a wimple.

There was also a version with the cloth under the chin but NOT over the head, and that was called a gorget:

As you can see, the amount of hair that needed to be covered changed across the middle ages, though in general, married women were pretty much always required to wear their hair up and neat. Loose hair was considered to indicate either a “maiden” (unmarried woman) or a “loose woman”.

Source