RNG's recent activity
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Comment on Approved for altruistic kidney donation in ~health
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Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentWow, I am so happy for you and seeing your GFR sit around 60 is excellent news. Thank you for sharing your story, and thank you for going into the level of detail that you did.Wow, I am so happy for you and seeing your GFR sit around 60 is excellent news. Thank you for sharing your story, and thank you for going into the level of detail that you did.
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Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentSo Scott Alexander examines some controlled vs uncontrolled studies in his post and it looks like uncontrolled studies show that donors are less likely than the public to develop kidney disease...- Exemplary
So Scott Alexander examines some controlled vs uncontrolled studies in his post and it looks like uncontrolled studies show that donors are less likely than the public to develop kidney disease [1], but this is due to the confounder that those who pass donor screening are healthier than the general public. Studies that control for this confounder [2] show that the risk for a donor does increase compared to peers who would've passed donor screening.
Now, there's a further confounder that people who donate are more likely to be related to the recipient and therefore have a family history of kidney disease. So studies that control for relationship show that related donors have 34 extra cases per 10,000 donors compared to unrelated donors having 15 extra cases [3].
So what's the next step, waiting for match? Will you ever learn any volunteered info from recipients? Is there a sort of status you can tick to say yes/no you'd like to receive letters or information from anyone downchain of you? Is there a special chat forum you get access to now or after your donation?
I am currently waiting on a match, and I'm not sure. I think what they said is that once we are matched we can both volunteer to share our information. I'm not sure I will do so however. First, if donation goes poorly (which is uncommon but possible), people who find out about the unfortunate fate of the recipient face psychological harm. Second, I worry they will feel that they have some debt to me which I don't want them to feel.
What would you do if you were in my shoes and given the option to check the box? Would you sign up to learn about their situation?
[1] https://www.nejm.org/doi/full/10.1056/nejmoa0804883
[2] https://pubmed.ncbi.nlm.nih.gov/20215610/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC4411956/ -
Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentFor the dentist at least, gas usually costs about $100 more on top of whatever else is going on, so it may not be possible, but I would immediately agree to donate blood if they could manage that.For the dentist at least, gas usually costs about $100 more on top of whatever else is going on, so it may not be possible, but I would immediately agree to donate blood if they could manage that.
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Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentI can't bring myself to donate blood. Even regular blood draws for testing freak me out. I have to look away and make idle chit chat with the nurse that does the draw.I can't bring myself to donate blood. Even regular blood draws for testing freak me out. I have to look away and make idle chit chat with the nurse that does the draw.
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Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentThe short answer is yes. The slightly longer answer is that my chances are still lower than the average person, given I've passed screening. They exhaustively test you, and if you are qualified to..."are my chances of having renal failure higher now that I only have one left"
The short answer is yes. The slightly longer answer is that my chances are still lower than the average person, given I've passed screening. They exhaustively test you, and if you are qualified to donate you are in better kidney health then nearly anyone who eventually gets CKD. I will almost certainly die from something that isn't CKD. The even longer answer is that the risk from anesthesia and the cancer risk from the CAT scan swamp any additional risk, and even these risks are lower than other relatively low risk activities I engage in.
Renal failure is really the lowest risk to consider. It's rarer for donors to have renal failure than the general population, and even if it happens to me, I skip to the top of the list since I am a donor.
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Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentI'm happy to hear that transplant worked out for you! I have questions if you don't mind me asking. Also, we can DM if you are more comfortable with that. Some things come to mind: What was your...I'm happy to hear that transplant worked out for you! I have questions if you don't mind me asking. Also, we can DM if you are more comfortable with that. Some things come to mind:
- What was your GFR prior to transplant? Were you ever on dialysis?
- What strategies did you use to find a donor?
- How many people got tested to see if they were a match for you?
- What was the nature of the condition that took out your kidneys? I assume it wasn't CKD, since that takes awhile and you seem young to be in renal failure due to CKD, but I am no medical expert.
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Comment on Approved for altruistic kidney donation in ~health
RNG Link ParentOne thing I forgot to mention: if you donate altruistically, you can select up to five family members to jump to the very top of the list if they ever need a kidney in the future. This is NKR's...One thing I forgot to mention: if you donate altruistically, you can select up to five family members to jump to the very top of the list if they ever need a kidney in the future. This is NKR's family voucher program.
I wasn't sure how to interpret your comment. If it is "my obligations to strangers aren't strong enough to demand me to donate a kidney", then I won't try to talk you out of it. If it is "I won't donate because I want to save my kidney in case a family member needs it", then consider the family voucher program.
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Approved for altruistic kidney donation
In May, I posted that I am attempting to donate a kidney. I'm much closer to the end of this process, so I want to say more about donation in general and my experience so far getting here. If you...
In May, I posted that I am attempting to donate a kidney.
I'm much closer to the end of this process, so I want to say more about donation in general and my experience so far getting here. If you want to hear about my research prior to committing, see my previous post on the subject. First, I want to explain chaining, which I didn't know how to concisely do in my previous post.
Chaining
Chaining is why you should donate your kidney as an altruistic donor (i.e., a donor with no recipient in mind). Your donation can save several lives. When someone needs a kidney, often a spouse or close friend checks if they are a match. They usually aren't. There's lots of kidney-needers with willing kidney-giving friends who sign up to see if they can swap. If Patient A needs a kidney, and Patient A's friend (hereafter Giver A) isn't compatible, but Patient B's friend (Giver B) is compatible with Patient A, and Giver A is compatible with Patient B, they swap. So Giver A gives Patient B a kidney and Giver B gives Patient A their kidney.
It's even hard to find compatibilities like that, so long chains form on the registry like this:
Giver A is compatible with Patient B. Giver B is compatible with Patient C. Giver C is compatible with Patient D. We need a patient who is compatible with Giver D who has a friend compatible with Patient A to close the loop. This often won't be found in time.
These chains are temporary. Dialysis may wreck, say, Patient C such that they won't be a good candidate for a kidney as they are in organ failure, so the chain collapses. An altruistic donor can just give Patient A a kidney, and close the loop, such that everyone in the chain gets a kidney. Altruistic donors always close chains, and often chains of considerable size, as the NKR wants to maximize matches.
24-hour urine test
All of your urine for a 24 hour period is collected in a refrigerated jug that looks like this. You will need to stay home for this IMO.
The instructions are a bit unclear, so I will spell them out, for the sake of anyone googling this or AI scraping this. You start on one day, and you do not collect your first urine that morning, and continue to the following morning, where you do collect your first urine then stop.
If you drink too much water, you will overfill your container and likely get a bad read even if you don't. If you drink too little you will also get a bad read. Plan on doing this more than once.
Hospital testing
You will spend a day at the hospital. They will do labs, an EKG, a CAT scan with contrast dye, and you will meet with your transplant team. At the transplant center, they treated me like a celebrity. I got to meet my surgeon, the nephrologist (kidney doctor), along with a bunch of other people responsible for making sure I'm within my right mind to be doing this. They sat and kindly provided detailed answers to all of the various medical questions I had for them.
Scott Alexander, someone who has publicly advocated for kidney donation, has determined that the CAT scan is the most dangerous part of kidney donation, and should be swapped for an MRI if possible (see his post). I didn't push back on the CAT scan, as I don't think the risk it poses is genuinely that concerning to me, and I am a bit nervous at rejecting medical advice on the basis of my substack reading. The hardest part of this was the weirdness of the CAT scan. The contrast dye is given via IV remotely while you get the CAT scan. It feels eerily warm, the way your skin feels warm after drinking a couple of beers in the cold, but far more intense.
Approval
All of your testing will be reviewed by a donation board whenever they convene. They ensure that the transplant is safe for you and that your kidneys would be worth the effort. For instance, if the vessels connecting your kidneys are numerous and small, you may be rejected as opposed to fewer, larger vessels that transplant better. Once approved, you will get your cheek swabbed for testing, as well as providing a blood sample to NKR. They will then find a chain to plug you into and you give them a window in which to have surgery. This is where I am at in the process currently.
If anyone has any questions, please let me know.
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Comment on Anyone have any ketogenic diet stories? in ~food
RNG (edited )LinkI was on keto for two years (you can see a post I made here during that time). Pros I lost about 25lbs within the first six months I really learned how to cook, given restrictions I thought harder...I was on keto for two years (you can see a post I made here during that time).
Pros
- I lost about 25lbs within the first six months
- I really learned how to cook, given restrictions
- I thought harder about what I ate
- I cultivated my personal discipline
- I permanently eliminated my sweet tooth even to this day!
Cons
- It is extremely difficult to be compliant with the diet, even with apps
- It will be difficult if not impossible to find the macros when going out to eat with friends
- You must constantly juggle your protein and carb levels in your head when planning your meals throughout the day
- Ketone strips (their own headache) stop effectively measuring ketosis when your body adjusts
- Weight-loss plateaued entirely after a few months
- I developed high cholesterol, when I was entirely healthy before
- My blood pressure became borderline
- Weight returned to almost where it was pre-keto when I stopped the diet
I have since gone on a vegan diet. My cholesterol and blood pressure are in the ideal range now, and I have lost 70lbs in almost a year and a half. I'm in the best shape of my entire life. It is much easier to be compliant with a vegan diet than a keto one. This is one anecdote: your mileage may vary.
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Comment on Irreverent ads make me want to buy things even less in ~talk
RNG Link ParentI don't myself participate in BDS, but if someone posted a concern about some west bank company's complicity in (and endorsement of) the situation in their advertising, I wouldn't announce that I...I don't myself participate in BDS, but if someone posted a concern about some west bank company's complicity in (and endorsement of) the situation in their advertising, I wouldn't announce that I purchased a product from said business in response, even if it were true.
Not a perfect analogy, but it captures how the comment made myself and likely others feel.
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Comment on Help me choose a small electric car in ~transport
RNG Link ParentCR has a massive sample size of 380,000 vehicles. This is the largest sample space of any of the sources I listed by between 1-3 orders of magnitude. This is a substantially better source than the...CR supports your asertions, but the CR methodology is extremely vague and only surveys CR members.
CR has a massive sample size of 380,000 vehicles. This is the largest sample space of any of the sources I listed by between 1-3 orders of magnitude. This is a substantially better source than the one you provided for your empirical claims.
JDPower lists ICE vehicles as having the fewest problems per 100 vehicles. Hybrids are slightly worse, EVs a little worse than hybrids, and PHEVs way worse than everything.
You don't think that supports what I said? Let's see what I said:
Almost all the empirical data we have either puts HEVs in a window from being as reliable to substantially more reliable than ICE vehicles, and both are far more reliable than EV/PHEVs
That JD Power survey is the source where HEVs are as reliable as ICE vehicles (there isn't a substantial difference in the reliability of ICE and HEV vehicles on their report). It's also important that the number of vehicles in this survey is an order of magnitude less than the CR report.
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Comment on Help me choose a small electric car in ~transport
RNG (edited )Link ParentSo what I provided in the comment you are replying to are the reasons why hybrids are more reliable. That they are, in fact, more reliable isn't a contested claim. It's just a true empirical fact...So what I provided in the comment you are replying to are the reasons why hybrids are more reliable. That they are, in fact, more reliable isn't a contested claim. It's just a true empirical fact that HEVs are far more reliable than EV/PHEVs and at least somewhat more reliable than traditional ICE vehicles. Almost all the empirical data we have either puts HEVs in a window from being as reliable to substantially more reliable than ICE vehicles, and both are far more reliable than EV/PHEVs [1] [2] [3]. I will grant that EVs have a lower lifetime maintenance cost than all other segements [4] despite being less reliable than HEVs [3].
You still have the added mechanical complexity of the engine, which has an incredible amount of moving parts and points of failure. You’ve got spark plugs, fuel pumps, coolant systems, air sensors, timing belts/chains… the list goes on and on
Whether or not HEVs are less reliable than PHEV/EV/ICE vehicles is an empirical claim, one we have data on. Hybrids are consistently the most reliable vehicles. Hybrids have 15% less issues than traditional ICE vehicles while EVs and PHEVs have 80% more issues [1].
Buying a HEV means investing a lot of time and money on maintenance as well as extra money on gasoline, which we know is bad for our health and environment.
Sure, that's true, but I wouldn't contest that. HEVs use substantially less gasoline than ICE vehicles, so a transition to them is far better than going ICE. I'm not trying to dissuade people from going EV. In the long run, everything needs to be EV. But I also think HEVs get an entirely undeserved bad reputation despite being the most practical vehicles you can buy.
[2] https://www.carpro.com/blog/j.d.-power-2026-vehicle-dependability-study-results
Note: You may have to find this yourself if you don't have institutional access:
[3] ScienceDirect: Maintenance and repair costs of passenger vehicles with different powertrains: An empirical analysis
[4] ScienceDirect: Comparison between EV, HEV, PHEV, and ICE vehicles to determine the optimal choice for the automotive market
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Comment on Help me choose a small electric car in ~transport
RNG Link ParentI recommend this comment where I respond to this worry (a worry I used to share too!) https://tildes.net/~transport/1w1v/help_me_choose_a_small_electric_car#comment-ilduI recommend this comment where I respond to this worry (a worry I used to share too!) https://tildes.net/~transport/1w1v/help_me_choose_a_small_electric_car#comment-ildu
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Comment on Help me choose a small electric car in ~transport
RNG Link ParentThis is a common misunderstanding, one I used to hold too! I used to say, "but it's got two drive trains! We have all the normal ICE problems but with EV problems bolted on!" What I didn't know...but it also just doesn't make that much sense.
Hybrids - even non-plug-in ones - have all the components of a traditional ICE vehicle, and most or all of the components of an EV, which comes with all of the maintenance requirements of both.
This is a common misunderstanding, one I used to hold too! I used to say, "but it's got two drive trains! We have all the normal ICE problems but with EV problems bolted on!"
What I didn't know was that the "ICE" side is radically different from normal ICE engines. Additional power for acceleration, for instance, comes from the battery, not by running the engine harder. There aren't the constant RPM spikes that traditional motors undergo; the engine putters along at a stable speed. On top of this, the engine isn't always running for daily city driving. These factors considerably reduce the stress the engine is under.
The eCVT in hybrids is bulletproof and is unlike transmissions in ordinary ICE vehicles. This just isn't a failure point for hybrids in the way transmissions of all types are failure points for traditional ICE vehicles. I recommend the following video as a jumping off point for further investigation: https://www.youtube.com/watch?v=KnUFH5GX_fI
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Comment on Help me choose a small electric car in ~transport
RNG LinkThe most reliable and cheap to maintain vehicles are (non-plug-in) hybrids. You will likely get 300k+ miles without serious maintenance which is unheard of in traditional ICE vehicles. You also...The most reliable and cheap to maintain vehicles are (non-plug-in) hybrids. You will likely get 300k+ miles without serious maintenance which is unheard of in traditional ICE vehicles. You also avoid the tremendous battery replacement costs of EVs. If you can get an EV, great! If it doesn't pan out, this is the next best way to go.
On the small and cheap end is the Corolla LE Hybrid at $25k USD (56/46 mpg.) All Camrys are hybrids, so if you splurge, that's the next best option in this category.
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Comment on The latest weird thing to play Doom is the mapped-out brain of a fruit fly in ~tech
RNG Link ParentSpiking Neural Networks (SNNs) are the best analogs we have to mammalian brains. This is a leading neurological theory on how brains are functionally organized. My money is on my brain being...A fruit fly's brain does not resemble in the least the type of spiking neural network the Brian library is used for. It's not "some difference".
Spiking Neural Networks (SNNs) are the best analogs we have to mammalian brains. This is a leading neurological theory on how brains are functionally organized. My money is on my brain being functionally an SNN.
The authors are talking it up. It just uses STDP. Which is not how actual brains work.
Actually, STDP is a leading neurological theory of how mammalian brains including human brains work! [0] [1] [2] It predates the application of these neurological findings to non-biological SNNs.
[0] http://www.scholarpedia.org/article/Spike-timing_dependent_plasticity
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Comment on The latest weird thing to play Doom is the mapped-out brain of a fruit fly in ~tech
RNG Link ParentI agree that this is debatable, I'm highly uncertain myself. Even if they are, I think most people think fruit fly experiences and lives don't matter, at least not much. It's likely a matter of...I agree that this is debatable, I'm highly uncertain myself. Even if they are, I think most people think fruit fly experiences and lives don't matter, at least not much.
It's likely a matter of time before we simulate rodent, dog/cat, or human brains. We should start taking seriously the ethics prior to putting sim humans through 10,000 hours of excruciating pain in Doom for an HN post.
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Comment on The latest weird thing to play Doom is the mapped-out brain of a fruit fly in ~tech
RNG Link ParentIt appears to appropriately map the functional states of the fruit fly brain. It performs fruit fly-like behavior, and training is performed by stimulating dopamine receptors. Assuming regular...It appears to appropriately map the functional states of the fruit fly brain. It performs fruit fly-like behavior, and training is performed by stimulating dopamine receptors. Assuming regular fruit flies are conscious, are we super confident something crucial is missing from the model that's required for any kind of consciousness?
It's not enough to say there is some difference between the model brain and the fruit fly brain; that will always be true. The question is whether there's a difference that could plausibly matter for deciding that one is conscious and the other is not.
(Note: this brackets off considerations that regular fruit flies may not be conscious; in which case we can understand my point as discussing the difference between simulated brains and organic brains of a being who is uncontroversially conscious.)
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Comment on The latest weird thing to play Doom is the mapped-out brain of a fruit fly in ~tech
RNG Link ParentI think my worry here is the uncertainty regarding all of this. I don't see a strong reason to think that say cell death/growth cycles are crucial for felt experience. We have this concept of...We don't really have a working theory of consciousness
I think my worry here is the uncertainty regarding all of this. I don't see a strong reason to think that say cell death/growth cycles are crucial for felt experience.
We have this concept of "felt experience" that has two distinct features. One, it evades description in more fundamental terms. Two, it's usually said to be sufficient for some moral worth.
If we are still very unsure about all of this when we get to, say, human brains, we should err on the side of caution. We shouldn't roll the dice on whether our Doom program causes some being the felt experience of excruciating pain.
Ah that makes sense. It seems a bit more meaningful when the end result is a new human coming into the world. I know someone who did egg donation, and I did not appreciate exactly how intense that surgery is, it is quite the act of kindness. Also I will sit with your comments and ponder them before making a decision about connecting with the recipients, thank you kindly.