Thursday, February 12, 2026

On Crocodiles

1. What Crocodiles Actually Eat

Crocodiles are obligate carnivores. Their diet includes:

  • Fish

  • Birds

  • Mammals

  • Reptiles

  • Carrion (dead animals)

So their nutrients come almost entirely from animal tissue, not plants.

2. How Croodiles Get Each Macronutrient

A. Proteins (Primary Energy & Structure Source)

Source

  • Muscle tissue

  • Organs

  • Skin

  • Tendons

Digestion

  • Powerful stomach acid (pH ≈ 1–2, similar to vultures)

  • Pepsin breaks proteins into peptides

  • Pancreatic proteases (trypsin, chymotrypsin) finish digestion in the small intestine

Use

  • Tissue growth and repair

  • Enzyme and hormone synthesis

  • Can be converted into glucose via gluconeogenesis

Protein is king in crocodile metabolism.

B. Fats (Major Energy Reserve)

Source

  • Adipose tissue

  • Marrow

  • Brain tissue

  • Fish oils

Digestion

  • Bile emulsifies fats

  • Pancreatic lipase breaks triglycerides into fatty acids + monoglycerides

  • Absorbed into intestinal cells and transported via lymph

Use

  • Primary long-term energy source

  • Stored in fat bodies and liver

  • Used heavily during long fasting periods (weeks to months)

Crocodiles rely on fat oxidation for survival between meals.

C. Carbohydrates (Minimal, Indirect)

Source

  • Glycogen stored in prey muscle and liver

  • Trace sugars in blood and tissues

  • Small amounts from gut contents of prey

Digestion

  • Very limited amylase activity

  • Simple sugars absorbed directly

Metabolism

  • Stored briefly as liver glycogen

  • Mostly produced internally via gluconeogenesis from:

    • Amino acids

    • Glycerol (from fat breakdown)

Crocodiles do not depend on dietary carbohydrates.

3. Unique Digestive Adaptations

🔹 Gastroliths (Stomach Stones)

  • Help grind food

  • Improve mechanical digestion

  • Possibly aid buoyancy control

🔹 Exceptionally Acidic Stomach

  • Dissolves bones, hooves, feathers

  • Allows mineral absorption (calcium, phosphorus)

  • Kills pathogens

🔹 Slow Metabolism

  • Ectothermic → low energy needs

  • Can go months without eating

  • Digestion can take days to weeks

4. Absorption & Transport

NutrientAbsorption SiteTransport
Amino acidsSmall intestinePortal vein → liver
Fatty acidsSmall intestineLymphatic system
GlucoseSmall intestinePortal vein

5. Energy Strategy Summary

MacronutrientImportance
Protein⭐⭐⭐⭐⭐ (primary)
Fat⭐⭐⭐⭐ (long-term energy)
Carbs⭐ (minor, indirect)

Crocodiles are metabolically designed to:

  • Eat large meals

  • Digest slowly

  • Run on fat and protein

  • Manufacture glucose internally

6. Big Picture (Clinical Analogy)

If humans are glucose-driven, crocodiles are fat-and-protein driven survival machines.

They don’t “eat carbs”, they make what little glucose they need.

GI Enzymes Note

GI enzymes (very exam-relevant):

1. Lactase Deficiency (Lactose Intolerance)

Problem

Lactase at brush border

Result

Lactose not digested → stays in lumen

Symptoms

  • Bloating

  • Gas

  • Osmotic diarrhea

  • Abdominal cramps

Why?

Undigested lactose → fermented by bacteria → gas + osmotic load

Key Point

✔ Not an allergy
✔ Very common
✔ Worse with age / post-infection

2. Pancreatic Insufficiency

Seen in:

  • Chronic pancreatitis

  • Cystic fibrosis

  • Pancreatic cancer

Problem

↓ Pancreatic enzymes (lipase most important)

Symptoms

  • Steatorrhea (fatty stools)

  • Weight loss

  • Fat-soluble vitamin deficiency (A, D, E, K)

Why fat first?

Lipase is most vulnerable enzyme

Stool

  • Bulky

  • Pale

  • Floating

  • Foul-smelling

3. Acute Pancreatitis

Key Enzymes

  • Lipase (most specific)

  • Amylase

Diagnosis

↑ Serum lipase

Mechanism

Premature activation of trypsin → autodigestion

Clinical Clues

  • Epigastric pain → radiates to back

  • Nausea/vomiting

4. Enteropeptidase (Enterokinase) Deficiency

Problem

Cannot activate trypsinogen → trypsin

Effect

↓ Activation of ALL pancreatic proteases

Symptoms

  • Severe protein malabsorption

  • Failure to thrive (infants)

Rare but classic test question

5. Pepsin / Achlorhydria

Seen in:

  • Pernicious anemia

  • Chronic gastritis

  • PPI overuse (mild effect)

Problem

↓ HCl → ↓ pepsin activation

Result

↓ Protein digestion

Also affects

  • Iron absorption

  • B12 release from food

6. Cystic Fibrosis

Problem

Thick secretions block pancreatic ducts

Effect

↓ Enzyme delivery

Symptoms

  • Steatorrhea

  • Malnutrition

  • Fat-soluble vitamin deficiency

7. Lipase vs Amylase (Exam Favorite)

EnzymeClinical Value
LipaseMore specific for pancreatitis
AmylaseLess specific (also ↑ in salivary disease)

8. Brush Border Damage

Seen in:

  • Celiac disease

  • Gastroenteritis

Problem

↓ Disaccharidases (especially lactase)

Symptoms

Secondary lactose intolerance

9. Trypsin’s Central Role

Trypsin activates:

  • Chymotrypsinogen

  • Procarboxypeptidase

  • Proelastase

Clinical Relevance

Premature trypsin activation → pancreatitis

10. Fat Malabsorption Consequences

Due to ↓ lipase / bile / mucosal disease:

Deficiencies

  • Vitamin A → night blindness

  • Vitamin D → osteomalacia

  • Vitamin E → neuropathy

  • Vitamin K → bleeding

Exam Memory Tricks

Lipase = Pancreatitis
Steatorrhea = Fat digestion problem
Lactase = Most easily lost enzyme
Trypsin = Master activator

Lives of the 1% vrs The Rest of Humanity

Last year, I watched the Stanley Kubrick film Eyes Wide Shut because it was being talked about inline with the Epstein files. I always like to do my own independent inquires as to that popular media narrative. Maybe you’ve seen it. It’s got Tom Cruise wandering through this enormous Victorian Gothic mansion in a costume and a mask. He’s trying to fit in and observe rooms full of other mask-wearing people, most of whom are half-naked and who also happen to “own the planet.” They’re engaging in some very expensive, let’s say, very rhythmic breathing exercises.

Now, it’s easy to dismiss this as Kubrick being Kubrick, but I think he was really trying to reveal something to us with this film. We tend to think of secret societies as dark, cinematic fever dreams-velvet ropes, incense, passwords whispered in Latin or whatever. But we don’t feel particularly threatened because, if the people running the world were really that theatrical, we’d surely see them coming, right? We’d spot the cape in the elevator or wherever, and we’d be a little intrigued and probably somewhat amused.

But the thing is, the masks aren’t only made from Venetian porcelain. They’re also made out of high-frequency trading algorithms and non-disclosure agreements. They’re made from so-called philanthropic foundations with names so bland they sound like they were generated by a committee that’s never actually experienced an empathetic human emotion before.

We seem to have this societal obsession with the whole “secret club” angle because it gives us a target. We can categorize a shadowy room where a dozen guys in hoods decide which puppet goes where on the world stage. We fictionalize this perspective because it seems too bizarre to be taken seriously. But the reality is much more mundane and also a lot more terrifying because the secret isn’t that they’re hiding. The secret is that they’re doing it in plain sight, and we’re too busy arguing over the culture-war outrage of the week to notice that our pockets are being picked by a psychotic cloud lord who lives in a tax haven that doesn’t technically exist on a map.

We usually call these people “the 1%,” though they’re more accurately the 0.1% or 0.01%. That’s a clean, clinical term, a math term but it doesn’t quite capture the parasitic nature of the relationship. A parasite doesn’t really hate the host; it just views the host as a juice box. Right now, we’re being squeezed for every drop of attention and labor we have left, while being told that if we just hustled a little harder, it could be us holding the straw.

I’m convinced there’s a specific kind of rot that happens to the brain when it’s wrapped in one too many layers of zeros. It’s a psychological drift. There was a study done at UC Berkeley known as the “rigged Monopoly experiment.” They took two people and gave one of them twice as much money and two dice instead of one, effectively giving that player a ridiculous advantage. You’d probably assume the rich player would feel self-conscious, maybe even a little guilty about the blatant unfairness.

But exactly the opposite happened. Within minutes, the advantaged player started acting entitled, smacking their pieces down harder, eating more of the shared snacks, talking down to the poorer player, etc. Typical elitist behavior. When the game ended, the winner didn’t credit the rigged board. They talked about their strategy, their superior skill.

We are long past observing social experiments in a lab. We’re currently living through a period of unmasking that makes Kubrick’s fiction look like a Sunday school picnic. Presently, we’re seeing the psychological reality of this unhinged elite class through the horrific files being posted on the website of the U.S. Department of Justice. When you look at those files the transcripts, the clips surfacing you begin to realize that rampant underage trafficking isn’t even the most disturbing part. I won’t go into gruesome details here; others are already doing that.

As I looked through those materials, I realized we’re not just looking at crimes. We are looking at a specific kind of pathology associated with obscene wealth and power. Some of this involves the so-called dark triad of personality traits: narcissism, Machiavellianism, and psychopathy, all running at scale. At a certain level of power, other human beings cease to be seen as people and become utility units - or worse, disposable toys for depraved whims.

It’s a form of moral immunity. These people spend so much of their lives living above the law that they come to believe they’re above the human condition itself. One of the most disturbing parts isn’t just the evil -it’s the fact that it’s documented and visible, as if impunity is being asserted openly. The records sit there in black and white, revealing a level of systemic depravity that suggests autocracy isn’t merely an economic category. For some at the very top, it’s a diagnosis.

We’ve been conditioned to think of “the elite” as a cohesive James Bond villain entity. But that may be too generous. It’s less a conspiracy and more a shared structural incentive. G. William Domhoff spent years studying power structures, and what he described wasn’t a secret government but something like “a very long, very expensive lunch” networks of policy groups, think tanks, and exclusive clubs where the governing class informally agrees on what reality will look like for the rest of us.

They’re not necessarily hiding the truth. The truth is simply locked behind a $50,000-a-plate fundraiser.

This brings us to the strange techno-feudalist turn we’ve taken. We aren’t really consumers anymore, that’s a 20th-century term. Consumers have choice. We’re more like digital sharecroppers. We live our lives on digital estates owned by a handful of cloud lords. Every scroll, every frustrated post into the void of social media, becomes free micro-labor refining their algorithms. Our attention is extracted as rent. We are the raw material.

It’s a closed loop: a parasitic circuit where human experience is harvested to train systems that may eventually replace us. It’s like being asked to help build the cage you’re standing in, then being congratulated on your engagement levels.

This system survives on manufactured distraction. We feel sudden spikes in collective outrage, cancel culture one week, some new symbolic conflict the next. It’s not that these issues don’t matter on a human level; they do. But they’re amplified and distorted in ways that keep us fighting horizontally rather than looking vertically at the concentration of wealth and power.

If you can keep the bottom 99% fighting over cultural validation, they’ll never turn their eyes upward. Empathy, tribalism, insecurity-all weaponized as smoke screens.

When control over information and surveillance tools becomes total, you don’t even need to win arguments. You just make truth irrelevant. Flood the space with misinformation until people give up trying to see clearly. Oppression isn’t always a boot on the neck. Sometimes it’s sedation by a thousand tiny digital needles while the environment and social safety nets are stripped for parts in the background.

We’re told “the other side” is the enemy, while those selling the weapons foreclose on our future.

Let’s talk about the silent sacrifice. This isn’t just about empty bank accounts or housing insecurity. It’s about the physical world being treated like an all-you-can-eat buffet for those already full. The “wealth defense industry”- armies of lawyers and accountants- constructs elaborate legal labyrinths to ensure the laws of economics barely apply to the ultra-rich.

But money alone isn’t enough to keep that club together. Power requires collateral. Mutual blackmail-kompromat-becomes the ultimate social glue. If everyone has leverage over everyone else, nobody can leave the room. Stability through shared vulnerability.

Meanwhile, the host- the planet, society, even the air we breathe-is gutted for short-term yield. We’re told environmental collapse is a collective failure, while a single private jet can produce more carbon than most individuals generate in years.

The elite aren’t necessarily repairing the world. Many appear to be building lifeboats.

This is the techno-feudal reality: we, the serfs, providing the labor and data that fund the bunkers. The most brilliant part? We’re made to feel guilty for the damage we barely influence.

So where does this leave us? This is usually the part where someone tells you to vote or sign a petition. But if the system functions like a vacuum for wealth and attention, asking it to stop may be like asking a shark to become a vegan.

The uncomfortable truth isn’t just that they’re powerful. It’s that they’re powered by us- at least for now.

Our ignorance is fuel. Our outrage is lubricant. Every time we take the bait on a manufactured conflict, we hand over another battery.

How do you stop a parasite? You make the host inhospitable.

We stop waiting for saviors. No billionaire visionary or polished politician is coming to dismantle the penthouse from the inside. The first step is a radical form of intellectual self-defense: developing a filter fine enough to catch propaganda. Looking at a viral headline and asking, “Who does this want me to hate, and how does that hate keep me from questioning power?”

We starve the attention economy. A château without serfs is just an empty house.

We move toward decentralization, in news, data, finance, and community life. Build parallel structures rather than endlessly fighting entrenched ones. Support voices not on the payroll. Reclaim the local. Strengthen face-to-face networks and systems that don’t require algorithms to function.

We are not going to cure the darker aspects of human nature. Predatory personalities are a recurring feature of our species. But their impact is magnified by massive, opaque, centralized systems.

You don’t fix a parasite. You stop being a host.

While some build bunkers, we can build alternatives. Imperfect, perhaps- but more humane and functional. After all, they are less than 1% of the population, a fact that becomes less abstract the longer we look away from our screens.

Reports for field Day Feb 12th 2026

CASE 1 Med‑Surg Shift Report 

Age: 77 
Gender: Male 
Current Code Status: Full Code 

Chief Complaint / Reason for Admission: Ambulatory dysfunction after fall → found to have left periprosthetic hip fracture. 

Allergies: NKA

Diagnosis / Working Diagnosis: 

  • Acute periprosthetic left hip fracture 

  • AKI likely 2/2 dehydration 

  • Leukocytosis (reactive vs infection) 

  • Anemia 

  • DM, HTN, HLD, CHF, AF, SSS 

Past Medical History: Bilateral hip arthroplasty, A‑fib on Eliquis, sick sinus syndrome s/p PPM, chronic diastolic CHF, DM, HTN, HLD, BPH. 

Bed Type: Med‑Surg / Tele (due to arrhythmia history) 

Rhythm Type: NSR (PM/telemetry) 

Neuro: A&O ×4; baseline intact. No LOC. Pain present r/t fracture. Fall risk. 

Respiratory: Lungs clear; RA; no SOB or increased WOB. 

Cardiovascular: HR controlled; BP stable. Hx CHF/AF/PPM. Pulses intact. 

GI: NPO. Abd soft, BS present. No N/V. 

GU: Voiding; monitoring due to AKI. Urine studies pending. 

Skin/Wounds: No acute wounds. High fall risk; monitor for breakdown. 

Musculoskeletal / Mobility: Severely limited mobility due to fracture. Requires full assist. 

Vitals: q4h Hemodynamically stable. 

Lines / Access: PIV ×1, site CDI. 

Diet: NPO for possible OR. 

Accu‑Checks: Yes — q6h while NPO; ISS held. 

Pain Management: Tylenol + gabapentin; monitoring response. 

Orders & Follow‑Ups: 

  • Ortho consult AM 

  • Cardiology consult AM for clearance 

  • PT/OT 

  • Iron studies, ferritin 

  • Urine studies 

  • XR formal reads 

  • IVF LR @ 50 mL/hr 

  •  

VTE Prophylaxis: SCDs only Eliquis held 

Discharge Plan: Not medically ready. Requires ortho plan & mobility evaluation. 

Additional Notes / Concerns: Monitor fluid balance closely due to CHF + AKI. Safety precautions. 

 

CASE 2Med‑Surg Shift Report 

Age: 70 
Gender: Male 
Current Code Status: Full Code 

Chief Complaint / Reason for Admission: 

Suprapubic catheter dysfunction- catheter not draining; urine via urethra. 

Allergies: None reported. 

Diagnosis / Working Diagnosis: SPC malfunction / obstruction 

Past Medical History: Morbid obesity, lymphedema, chronic venous ulcers, SVT s/p ablation, varicose veins, BPH, chronic back pain. 

Bed Type: Med‑Surg 

Rhythm Type: NSR 

Neuro:A&O ×4. No pain or acute changes. 

Respiratory: Clear, RA, no distress. 

Cardiovascular: HR 99; BP stable. No edema beyond baseline lymphedema. 

GI:Abd soft, nondistended. Regular diet tolerated. 

GU:SPC not draining; urine from urethra. No dysuria or fever. 

Skin/Wounds: Chronic LE skin changes from venous disease; intact. 

Musculoskeletal / Mobility: Baseline limited due to habitus; ambulates short distances. 

Vitals: q4h 

Lines / Access: PIV ×1 

Diet: Regular 

Accu‑Checks: No 

Pain Management: Percocet PRN 

Orders & Follow‑Ups: 

  • Urology & IR consult for catheter replacement 

  • Monitor for infection signs 

  • Continue observation only 

VTE Prophylaxis: Lovenox 

Discharge Plan: Return to rehab once the catheter is functional. 

Additional Notes / Concerns: High BMI makes catheter access difficult; monitor for retention. 

 

CASE 3 Med‑Surg Shift Report 

Age: 83 

Gender: Male 
Current Code Status: Full Code 

Chief Complaint / Reason for Admission: Shortness of breath → CHF exacerbation + severe hyponatremia (Na 121). 

Allergies: Amoxicillin, Penicillins, Ramipril. 

Diagnosis / Working Diagnosis: Acute on chronic systolic CHF exacerbationHypervolemic hyponatremia 

Past Medical History: CHF, CAD, AF, HTN, HLD, DM2, CKD4, BPH. 

Bed Type: Med‑Surg / Telemetry 

Rhythm Type: NSR with 1° AV block 

Neuro: A&O ×4 

Respiratory: RA 

Cardiovascular: Elevated BP; baseline CHF. Bilateral LE edema. 

GI: Soft abdomen; regular diet ordered (heart healthy). No N/V. 

GU: Cr 2.0 (baseline CKD4). Poor UOP initially; monitor output post‑diuresis. 

Skin/Wounds: Skin intact; chronic stasis changes. 

Musculoskeletal / Mobility: Ambulates with assistance; edema impacts mobility. 

Vitals: q4h with BMP q4h after urination. 

Lines / Access: PIV x1 left 20G 

Diet: Heart Healthy 

Accu‑Checks: YesACHS (Lantus + SSI) 

Pain Management: No active pain 

Orders & Follow‑Ups: 

  • Lasix 20 mg IV 

  • BMP q4h: 8am, 12pm and 4 pm BNP needed. 

  • Telemetry 

  • Hold metoprolol & amlodipine 

  • Daily weights, strict I/O 

  • Glucose management 

VTE Prophylaxis: Heparin 

Discharge Plan: Needs electrolyte stabilization; not ready for discharge. 

Additional Notes / Concerns: Monitor sodium closely to prevent rapid correction. 

CASE 4 Med‑Surg Shift Report 

Age: 82 
Gender: Female 
Current Code Status: Full Code 

Chief Complaint / Reason for Admission: Presyncope with dizziness, vision changes, fall. 

Allergies: Doxycycline, iodine/contrast, ketorolac, naproxen, risperidone. 

Diagnosis / Working Diagnosis: 

  • Presyncope 

  • Sinus bradycardia 

  • Anemia 

  • Hx autoimmune disease (MCTD, sarcoid) 

Past Medical History: Anxiety, HTN, IBS, autoimmune disease, OA, glaucoma, sarcoidosis. 

Bed Type: Med‑Surg / Telemetry 

Rhythm Type: Sinus bradycardia 

Neuro: A&O ×4; dizziness improved. No focal deficits. 

Respiratory: RA. 

Cardiovascular: Bradycardic; BP elevated. No chest pain. 

Tele:  

GI: Regular diet; no GI symptoms. 

GU: Voiding independently. 

Skin/Wounds: No skin breakdown; chronic knee swelling. 

Musculoskeletal / Mobility: Unsteady gait; PT ordered; fall risk high. 

Vitals: q4h 

Lines / Access: PIV x1 left AC 18G 

Diet: Regular 

Accu‑Checks: ACHS 

Pain Management: Reports mild pain from fall; PRN Tylenol as needed. 

Orders & Follow‑Ups: 

  • Telemetry 

  • PT eval 

  • Continue buspirone, fluoxetine 

  • Continue amlodipine, metoprolol, losartan 

VTE Prophylaxis: Lovenox 

Discharge Plan: Pending PT safety assessment. 

Additional Notes / Concerns: Monitor for recurrent dizziness; orthostatic recommended. 

 

CASE 5 Med‑Surg Shift Report 

Age: 60 
Gender: Male 
Current Code Status: Full Code 

Chief Complaint / Reason for Admission: Severe bilateral foot pain → inability to walk. 

Allergies: None known. 

Diagnosis / Working Diagnosis: 

  • Bilateral foot infection 

  • Concern for cellulitis vs frostbite vs ischemia 

  • Necrotic toe lesions 

  • Leukocytosis 16.97 

Past Medical History: No major PMH; ex‑smoker. 

Bed Type: Med‑Surg 

Rhythm Type: NSR 

Neuro: A&O ×4; severe foot pain. 

Respiratory: RA. 

Cardiovascular: Tachycardia resolved. Pulses present via Doppler. 

GI: Regular diet. 

GU: Voiding normally. 

Skin/Wounds: 

  • Bilateral foot erythema 

  • Dusky discoloration 

  • Green patches 

  • Black eschar on R great & 2nd toe 

  • Edema R +1, L +2 

Musculoskeletal / Mobility: Unable to ambulate; bedbound due to pain. 

Vitals: q4h 

Lines / Access: PIV x1 LAC 20G 

Diet: Regular 

Accu‑Checks: No 

Pain Management: PRN analgesics; monitor effectiveness. 

Orders & Follow‑Ups: 

  • Continue Unasyn IV 

  • Foot X‑ray 

  • ESR, CRP, CK 

  • Podiatry consult 

  • Wound Care consult 

  • ID consult 

  • Consider Vascular 

VTE Prophylaxis: Lovenox 

Discharge Plan: Not medically ready. Requires wound assessment & infection control. 

Additional Notes / Concerns: High concern for ischemic changes; monitor perfusion closely. 

Note:  Potassium replacement x2 bags 

 

On Crocodiles

1. What Crocodiles Actually Eat Crocodiles are obligate carnivores . Their diet includes: Fish Birds Mammals Reptiles Carrion (dead animals)...