My mother had a bilateral knee replacement done in Oct 2023 in a tier-2 city by Doctor A. Left one done first without any problems and right one done 5 days later with complains of tingling and burning sensation (at the foot) post the surgery. The discharge summary advised bed rest, normal diet and physiotherapy.
Two months later, the problem still persisted along with increased pain. Doctor A advised futher rest, and was told it would take time since she has diabetes and hypertension since 8 years.
With no relief after another month, she developed a small superficial bed sore at the ankle that was treated by doctor B in a different hospital in the same tier-2 city (Doctor A travels frequently and was unavailable most of thr time). Doppler scan indicated dilated veins and no deep or superficial vein thrombosis. Doctor C was instructed by Doctor B to do a pressure dressing every 3-4 days at her residence.
Three months later, the bed sore at the ankle increased to 2-3ins while Doctor C kept adding pressure bandages and peeling any black areas.
Tired of Doctor C, she visited Doctor B again at the hospital and he was shocked at the extent of damage. He did another doppler test and reported that there was no arterial flow in lower tibial artery and calcified plaques in lower limb arteries. Ignoring Doctor D's advice of conducting an angioplasty immediately, he went ahead with debriedment and advised further pressure bandage and bed rest.
After going through all this ordeal alone, my mother now revealed to me (I live in a different country) and our other relatives all of the pain she was going through alone.
I immediately took her to Doctor E in a tier-1 city who diagnosed that she has a gangrene heel and has severe calcification in her lower arteries and one blockage at the knee that was possibly caused/aggravated by the knee replacement surgery. She was at the risk of amputation if we had waited longer. Angioplasty was done immediately requiring 3 balloons and she is on vacuum dressing for the last 3 weeks
She is now heeling at the good care of doctor E requiring high doses of antibiotics and in the near future will need plastic surgery to close the open wound.
I think she is:
Wronged by doctor A for not evaluating her condition properly before conducting the knee replacement
Wronged by Doctor B for ignoring advice by Doctor D (to perform an angioplasty stat) and jumping to clean the wound without addressing the main problem and to make a quick and large amount of money
Wronged by Doctor C by primarily being incompetent and not updating status to Doctor B.
I want to know what legal actions I can take and also want to possibly file a PIL to make sure this kind of malpractice does not happen to anybody.
Please guide.

Some background context. In January I got really sick and developed unilateral tinnitus in my right ear that would come and go, was also reactive sometimes. That went away 2 weeks later. During the appointment with my doctor she checked my ears and I was told that I have fluid build up and was prescribed a nostril steroid. Anyways the tinnitus went away in about 2 weeks like I stated. I lived two and a half months without experiencing any short bursts of tinnitus. Around the beginning of April I had a bad cough I got sick once again in which lead to my tinnitus returning. It's always in my right ear it's never consistent and it will be a short burst that comes and goes. In the beginning it was worse and would eventually keep getting better and better. My tinnitus seem to stop again for about 3 weeks but recently started up again randomly I think due to paranoia over me thinking certain sounds might cause the spike. Currently my tinnitus is gone for about 90% of the day only reacts to certain low bassy sounds and sometimes randomly when I'm lying down. My tennis isn't as bad as most of the people on here because it's never been a consistent humming or anything like that. I do in fact most of the day don't experience to notice at all and have moments of quietness. But I believe do the paranoia this is greatly impacted my life and I'm always wondering will it go away? And when it does will it ever come back? At this point I'm not sure what to do it's led to depression, anxiety and frustration. Only medical history that I can think of is I've developed some hypertension which I'm working on naturally with diet and exercise and I have some fat in my liver which was caused by poor diet which I'm also fixing with once again diet and exercise.
Also if it helps the tinnitus only usually lasts 3 to 5 seconds at most and then goes away.

TL;DR I've tried alot of meds already and nothing helped. Looking for advice or recommendations.
I'm on effexor 75mg xr in the morning. Clonidine 3x a day (it does nothing, more of a placebo) and was on mirtazipine 15mg but had to quit because it was making me wig out in my sleep. Like jerking my head side to side. And setting up in my sleep and starring forward. It also give me real bad RLS
So I've tried mirtazapine, Hydroxyzine, olanzapine, risperdone, sertraline, propranolol and a few others i dont remember right off.
My sister give ne a couple trazodone so Im going to try one tonight and see how that does me. I go to the psych Tuesday. I been thinking about asking her for wellbutrin to go with my effexor and see how she feels about nurotin/gabapentin 3x a day. She is against all controls though so probably label me as drug seeking. So anyone have any ideas as what else i could try? I been looking at lamictal, abilify, and a few others but would like some personal experiences with meds that didn't cause alot of side effects.

I tried to copy paste and reformat it but references didn't work so sorry about that, just go to the link.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818193

Dental diseases and procedures are common, troublesome, and expensive, exceeding spending on other major health conditions, such as diabetes, ischemic heart disease, hypertension, dementias, and breast cancer, in the US. Dental issues are relevant for internists because unmet dental care needs can be painful for patients. Excluding teeth from medical health care is arbitrary.
Evidence-based medicine, a movement that gained prominence in the 1990s, has profoundly affected the practice of medicine. Unfortunately, little progress has been made on using data from clinical trials to determine best practices for dental care. Instead, most dental care relies on practice patterns influenced by the economic pressures of running a dental practice, dentists’ professional training and opinions, and patients’ expectations, all of which tend to favor excessive diagnoses and interventions. The result is that while many people who have low income go without any dental care, those who can pay are subjected to overdiagnosis and overtreatment.
Overdiagnosis
Overdiagnosis occurs when conditions that will never cause harm are identified. Unnecessary treatments resulting from overdiagnosis subject patients to potential harm and waste valuable resources that could be used for necessary and effective treatments.
For example, dentists may treat early noncavitated caries lesions, aiming to prevent more advanced lesions, such as dentine cavities. A noncavitated caries lesion is a demineralized enamel spot (white spot lesion) without evidence of cavitation. The majority of white spot lesions will not progress,1 and there is no evidence that early treatment, except with fissure sealants, is generally more effective than no treatment in preventing dentine cavities.2 Paradoxically, these sealants are frequently overlooked or underused by dentists. Dental cavities are routinely filled in children, despite evidence that dental pain and infection rates due to dental cavities in primary teeth are similar (about 40%) in children who are randomized to teeth being filled or not being filled.3
Decline in Caries and the Impact on Dentists’ Workload
In the 1970s, there was an unexpected, extraordinary decline in the number of cavitated caries lesions seen in dental patients.4 This decline in the number of patients’ cavitated caries lesions affected dentists’ workload and has played a role in overdiagnosis and treatment in dentistry so that dentists can support their practices. This financial need led to more recommendations for regular 6-month visits.5 Two randomized clinical trials failed to demonstrate that 6-month intervals between dental checkups result in better oral health compared with longer intervals (up to 24 months), which led the authors of a Cochrane review to conclude: “Whether adults see their dentist for a check-up every 6 months or at personalized intervals based on their dentist’s assessment of their risk of dental disease does not affect tooth decay, gum disease, or quality of life. Longer intervals (up to 24 months) between checkups may not negatively affect these outcomes.”6 Nonetheless, the standard for dental visits remains every 6 months.
Scaling and Polishing
Another commonly performed procedure is scaling and polishing to prevent periodontitis, a common condition in middle-aged persons. Scaling removes plaque and calculus from the crown and root surfaces of the teeth and is performed using hand or ultrasonic scalers. Polishing, which entails the mechanical removal of extrinsic stains and deposits, is typically done using a rubber cup or bristle brush loaded with a prophylaxis paste.
The assumption has been that scaling and polishing can prevent gingivitis and periodontitis, thus potentially preventing tooth loss, pain, and mobility. However, to our knowledge there are no published clinical trials assessing these outcomes.7 The existing evidence only evaluates short-term surrogate outcomes. It suggests that treating periodontitis, specifically through root planing, leads to a slight enhancement in the gum-to-tooth attachment level among individuals with moderate to severe periodontitis.8 However, there does not appear to be any advantage to scaling and polishing for adults without periodontitis.9
Changing Financial Incentives
The prevailing dental economic model based on fee-for-service creates an environment of dental overdiagnosis and overtreatment. At the same time, many persons who do not have dental insurance cannot afford to pay out of pocket for dental care, creating a situation where people with low income or who are part of a racial and ethnic minority group are often underdiagnosed and undertreated. A value-based model, in which dentists are paid to maintain oral health rather than to deliver treatments like fillings, cleanings, and fluoride applications, could be more positive for oral health. A study conducted in Rio de Janeiro (and coauthored by one of us [P.N.]) found that, among patients without treatment indications, an average of 2 teeth were treated during a 6-month follow-up period. This number increased to 3.6 teeth if the patient had changed dentists.10 A clear need exists for trials to compare different methods of paying dentists to assess the impact on oral health and on overtreatment and undertreatment.
What Is the Way Forward?
We do not want to give the impression that dental care is not important. On the contrary, dental pain, oral abscesses, broken teeth, and inflamed tissues surrounding the teeth are common presentations to medical professionals, especially those working in urgent care settings. Similarly, good dentition is nutritionally important for eating a full diet and psychologically essential to a person’s sense of appearance. However, dental procedures should be based on effectiveness and safety.
It is true that many important dental outcomes (eg, tooth loss) may take a long time to assess. On the other hand, the human mouth offers an easy trial design in which some procedures, such as filling a tooth, could be determined by randomization when there is more than 1 tooth in the mouth with a cavity. Other common abnormalities can impact adjacent teeth (eg, periodontitis) and require a refined design (eg, randomization to quadrants or sextants).
Identifying which dental procedures are beneficial and ensuring that relevant dental associations update their guidelines accordingly provide an opportunity to allocate resources to those who need them the most. The aim is to reduce overdiagnosis and overtreatment while increasing necessary treatment.
Corresponding Author: Paulo Nadanovsky, DDS, PhD, Oswaldo Cruz Foundation, FIOCRUZ, Brazil, Rua Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil ([paulo.nadanovsky@gmail.com](mailto:paulo.nadanovsky@gmail.com)).
Published Online: May 6, 2024. doi:10.1001/jamainternmed.2024.0222
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank Steven Woloshin, MD, MS, The Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and The Lisa Schwartz Foundation for Truth in Medicine, for his invaluable intellectual contributions to the development, writing, and critical revision of this paper. Dr Woloshin was not compensated for his contributions.

REFERENCES
1.Ferreira Zandoná A, Santiago E, Eckert GJ, et al. The natural history of dental caries lesions: a 4-year observational study.  J Dent Res. 2012;91(9):841-846. doi:10.1177/0022034512455030PubMedGoogle ScholarCrossref2.Bomfim AR. O Tratamento da Lesão de Cárie Dentária Não Cavitada é Efetivo? Uma Revisão Sistemática. Dissertation. Universidade do Estado do Rio de Janeiro; 2022. Accessed April 1, 2024. https://www.bdtd.uerj.br:8443/handle/1/186113.Innes NP, Clarkson JE, Douglas GVA, et al. Child caries management: a randomized controlled trial in dental practice.  J Dent Res. 2020;99(1):36-43. doi:10.1177/0022034519888882PubMedGoogle ScholarCrossref4.Nadanovsky P, Sheiham A. Relative contribution of dental services to the changes in caries levels of 12-year-old children in 18 industrialized countries in the 1970s and early 1980s.  Community Dent Oral Epidemiol. 1995;23(6):331-339. doi:10.1111/j.1600-0528.1995.tb00258.xPubMedGoogle ScholarCrossref5.Sheiham A. Is there a scientific basis for six-monthly dental examinations?  Lancet. 1977;2(8035):442-444. doi:10.1016/S0140-6736(77)90620-190620-1)PubMedGoogle ScholarCrossref90620-1)6.Fee PA, Riley P, Worthington HV, Clarkson JE, Boyers D, Beirne PV. Recall intervals for oral health in primary care patients.  Cochrane Database Syst Rev. 2020;10(10):CD004346.PubMedGoogle Scholar7.Hujoel PP. Endpoints in periodontal trials: the need for an evidence-based research approach.  Periodontol 2000. 2004;36:196-204. doi:10.1111/j.1600-0757.2004.03681.xPubMedGoogle ScholarCrossref8.Jervøe-Storm PM, Eberhard J, Needleman I, Worthington HV, Jepsen S. Full-mouth treatment modalities (within 24 hours) for periodontitis in adults.  Cochrane Database Syst Rev. 2022;6(6):CD004622.PubMedGoogle Scholar9.Lamont T, Worthington HV, Clarkson JE, Beirne PV. Routine scale and polish for periodontal health in adults.  Cochrane Database Syst Rev. 2018;12(12):CD004625. doi:10.1002/14651858.CD004625.pub5PubMedGoogle ScholarCrossref10.Naegele ER, Cunha-Cruz J, Nadanovsky P. Disparity between dental needs and dental treatment provided.  J Dent Res. 2010;89(9):975-979. doi:10.1177/0022034510369994PubMedGoogle ScholarCrossref

My sister (35) is my favorite sibling. Easily the single most selfless and loving human being I have ever known. She is a second mother to me and all our other siblings. Myself and her are the rock of a 7 children family. All my other siblings including me have at least one child. Save for the younger ones in college.
She has been married for 8 years and every single year after the honey moon, she has lost a child either stillborn or ectopic pregnancy. The closest one was 3 weeks to 9 months. A day before they could remove her to put her in the NICU is when she died. My sister found out when she went for the procedure. All of the babies have died after 6months so she has always had to push out corpses.
Her husband is the most supportive man I know. Despite all this, their marriage is incredibly strong and stable. They are one and the same. He has stood by her through it all.
Now, the second to last time she lost a child, I sat her down and told her that she should consider surrogacy. I went ahead and spoke to some facilities and even got an available surrogate that I both knew and trusted. I offered to foot half the bill. She told me to hang on and that she had seen another doctor that assured her this time round it will work. It didn’t.
After that baby died, we agreed she was going to take time off trying and just focus on other things. And try again after a few years or do surrogacy. Her excuse for not wanting surrogacy is that the process is painful. But is it really more painful than having labour induced to push out corpses?
She has done everything you can imagine. From seeing experts to herbal medicine to fucking voodoo. And NOTHING seems to cure the issue. The causes have ranged from her having hypertension to difficulties caused by previous losses. Her eggs are healthy but declining. Her husband is in good health too. They have never drunk or smoked and don’t drink or eat processed stuff. And somehow the babies keep dying.
I am angry because I am afraid she will die. Some doctors have told her this. She and her husband want the pride of making a “real” baby. One that is 100% theirs. They don’t see surrogacy as a real baby. Their fucking pride is going to take my sister from me.
I don’t know what to say to her. I haven’t called her yet. I don’t want to. She hid this pregnancy from me. I found out from my other siblings after it died. At 7 months.
I know how selfish I seem, that I care for my feelings more than hers but I have failed to make her see reason and it is fucking with me heavily. I have been there through it all. I have financed thousands of dollars worth of medical trips, vacations for mental health and everything in between. She has a very well paying job and can afford a surrogate. And I am willing to go halfway for her to achieve this. I will foot that bill. She just has to agree. But she just doesn’t fucking budge. I love her beyond words. But when I got the news, I wasn’t sad or shocked. Just plain angry.
Fuck!
Edit 1. For those saying it is best to back off, I partially agree. But not for the individualistic reasons given and not because “her marriage, her body her choice”. If you grew up with a family that is so deeply involved with each other, all 7 of us. It is next to impossible to just say “well, I tried. If she dies she dies”. Her being married does not suddenly make her less a responsibility to protect. And vice versa. Because if she died, it would be MY sister that died. Not my BIL’s wife. He would go on to remarry, I cannot make a copy of her. She is one of one. So it is next to impossible to just back off under there guise of “not my part” or “not my responsibility” because she is married. She doesn’t cease to be my sister. However invasive or controlling that may sound. Some families are very deeply intertwined and ours is one of those. But, I do agree that for my own mental health, I need to step back from it all and reduce how much energy I am allowing it to take. There is a middle ground where I can still help and save her health or life, while also not further harming my mental health or my relationship with her. I am yet to find it. But it is there.
Edit 2: Thanks a lot everyone for the kind advice and the personal stories shared. If not for me, I reckon somebody else learned something. My BIL called me to speak about it. He told me he knew I already knew what happened but he was still going through the motions. He told me the reason she hid the pregnancy from me was that she wanted it to be a surprise to me and if it was a boy, name it after me as a nod to the struggle I helped her through. And because I was going to be back into the country in 2 months, I would have found a new baby named after me. It shattered my heart even more. He said they have resolved to go the surrogacy route as they cannot afford to go through this again. He had taken a leave off work to cater to her. She was not doing as much as clearing the table or fetching a TV remote. He was doing everything to ensure she was not at all stressed or worked up. And it still didn’t work. So they have decided to not try again.
However, I told him about this post and shared some of the responses. Everything from blood clots to tumors to DNA mutations, Fibroids and everything suggested here. Some of the tests they had already done and only the DNA one and the brain tumor is the one he was certain they didn’t do. Either way, he said they will go the surrogacy route.
I thank everyone for both the kind and unkind words. I am certain someone else has read through this and it is reason they wont ever go through the same.
My sister and BIL also thank the subreddit for the comments. May the odds be ever in your favour.
Cheers!

TLDR: Why does autonomic dysreflexia cause flushing above the level of injury and pallor below the level of injury?
Question explained: My understanding: Person A has an injury at T2. Person A has a full bladderfull bladder trying to send a message up to brain like hey, full bladder, please empty memessage does not reach the brain because of injury at T2below the level of injury freaks out sympathetic nervous system activates (HTN, pupils dilate, vessels constriction)
The brain knows something is happening downstairs (below level of injury), tries to correct the freak out by sending/producing parasympathetic activity-bradycardia. But cannot reach pass the level of injury at T2.
So AD is basically causing this contrasting mess in the body= HA, hypertension, bradycardia. I would think it would cause flushing below the level of injury due to the HTN/constriction, and then pallor above the level of injury due to bradycardia/dilation.
So, why does autonomic dysreflexia cause flushing above the level of injury and pallor below the level of injury?

I randomly got very sick a few years ago. I am not sure of the cause, but I believe it may have been COVID, which I believe unfortunately spurred on a pretty severe autoimmune/inflammatory reaction. It came on very sudden, first with brain fog, then a dull pressure headache, and then muscle twitching, what felt like a fever, neuropathy on the left side of my body (It began in my face and went downwards, used to affect both sides but only the left side now), ear ringing, throbbing headaches, upper body burning pain, dizziness, memory issues, neck stiffness, sinus inflammation that caused watery mucus, and other issues. I remember one day about a month into my issues, I had an extreme warmness in my face and nearly constant ear ringing on and off. It was the strangest thing.
I was able to see a PCP about a month into my issues. My PCP did not seem to consider my issues of an urgent nature, even with sudden neuropathy, memory loss, dizziness, etc. I had a CT scan of my brain 3 months after initial illness which showed mild volume loss and possible encephalomalacia.
It took me a year to finally see a neurologist for it due to waiting times. The first one I saw was dismissive and literally told me to "wait it out" and see if I got better (I didn't). The second one I saw, and saw the longest, didn't even see me personally the first time, and had his nurse look at me instead, and did really nothing for my issues save for trying a very small dosage of Gabapentin for a few months as well as vitamin supplements, which I stopped taking due to it not doing anything for me. The third one I saw for a second opinion of the second one told me "I don't know what's causing your symptoms" and just left it at that. I saw a rheumatologist in 2022 who also didn't do anything for my neuropathy, just more blood work testing.
I recently found out the second neurologist I saw who I saw for years was successfully sued for malpractice while I saw him, but in another state. I believe he does telehealth neurology. He was sued in Georgia and settled for 175,000 dollars in late 2022. I had been seeing him since late 2021, and last saw him in person in late 2023 where he blamed my issues on "stress" and left it at that.
I told numerous doctors/specialists about chronic body inflammation feelings, such as intense upper body burning, head pressure, dizziness/vertigo, memory issues, neuropathy, etc. and they have never ordered a spinal tap to see if there was something in the CSF causing the chronic feeling. I have had brain MRIs that showed possible idiopathic intracranial hypertension with mild CSF buildup in the optic nerve and a partially empty sella turcica, but again, no spinal tap was ordered because my eye exam by a neuro-ophthalmologist was clean and showed no swelling. My brain MRIs also showed volume loss possibly caused by encephalomalacia, again, no spinal tap done.
I've had blood work for lupus and celiac that was negative, and an ANA rating that was barely positive. Normal rheumatoid factor and negative for Sjogren's as well. I just checked and I believe I am negative for vasculitis as well, Antineutrophil cytoplasmic antibody test was negative looking back at my testing in 2022. I also had a sinus CT scan a year into my issues that showed mild sinusitis. I am not diabetic but I was pre-diabetic when this began. Glucose testing has been normal, cholesterol is fine, lipids are fine. B12 is normal, but vitamin D is low.
It has been almost 3 years now and I still have neuropathy in certain parts of the left side of my body (mainly my face and genitals, I'm male and was born male) and again, nothing was done for me regarding a spinal tap, which is the only test outside of a PET scan that I haven't done which could be helpful for me as far as I know. I saw that third neurologist for a second opinion, and all he did was say maybe to get a spinal tap if I have chronic headaches, but other than that, like I said, he said outright he didn't know what was causing my symptoms.
I cannot work with how I feel, and it feels like neurologists and doctors in general left me to rot and deal with the chronic issues on my own, and now I'm going to be stuck with long-term, permanent issues such as nerve damage in my face and genitals because no doctor cares. I have ED and anorgasmia now along with the neuropathy that affects my genital area. It's just on the left side for some reason. It used to be tingling/burning on the left side of my genital area and face and now is reduced sensitivity issues. In 2021 I had a very sharp pain on the left side of my penis when I touched the right side of it, it was very scary and made me believe the nerve may have died, but that went away with very slow improvement, but that side is still not back to normal.
I still sometimes have dizziness and headaches, for instance, if I'm in a car and I watch the cars speed by us at an intersection, I'll feel sort of dizzy. It's not as bad as it was, but it's still not normal to feel like that, and no doctor has done anything for that or suggested it.
Am I wrong to think a spinal tap should have been ordered? Is there any reason they didn't, even after I asked? 0 out of the 3 neurologists I've seen in the past three years or so recommended one, so I did try getting second and even third opinions. The first neurologist genuinely just brushed me off, he didn't even order any testing. Just sent me on my way without a follow up appointment after saying to "wait it out".
I live in America and am on my state's Medicaid. I recently switched PCPs (my previous one was condescending and didn't seem interested in my issues) and the new PCP referred me to a new neurologist I'm going to see later this year, but it just feels at this point all they can do is assess the damage and not fix it due to it being so long since I got sick and my issues never really totally fixing itself.
I had an MRA of my head last month that was clean thankfully, so I think I didn't have a hemorrhagic stroke or some sort of blood vessel damage in my arteries. I saw a neurosurgeon about two weeks ago that I last saw in 2021 who still believes my cerebral atrophy (which I'm guessing is the volume loss likely caused by encephalomalacia) is abnormal for my age (mid-20s). The neurosurgeon's notes say my current neurologist believes I may have small fiber neuropathy as well as a cognitive disorder, but he has not prescribed a single thing since the low dosage of Gabapentin over two years ago.
The only real testing I have left is neuropsychological testing which will be a few hours. I am 90% positive that my issues are from something, likely a virus, causing severe chronic inflammation all over my body including my head. I was never in the past 3.5 years given anything to treat that inflammation.
I recently saw a new neurologist which is my 4th neurologist since 2021. He seemed genuinely interested in what had happened to me and found the symptoms frustrating because of how vague they were/are, but it was in a "I wish i knew so I could help you" way, which I've never seen with a previous doctor I've seen. He said a spinal tap in 2021 may have been useful but didn't think it was essential testing for my issues, said he might have tried Prednisone for a couple of weeks to see if it helped with inflammation, but that was it. He said since I'm still seeing very slow improvement, my nerves may still heal, but is that true, even this late into it? I feel the previous neurologists I saw didn't care at all, and I finally found one that does, but it's too late to make a difference. He said trying B12 supplements and Cymbalta might help. He wants me to get a lumbar MRI to see why I have nerve issues in my genital area. He didn't think I had GBS/AIDP or something like that either, but he did think a viral cause could be possible. He was all I could ask for a specialist like this, but again, seems too late to matter. I just don't know what to do.
TL;DR: Got very sick years ago, told doctors of body weakness and pain, what felt like inflammation in my body, nerve damage, memory issues, etc. was not given any real treatment for what was still occurring in my body, which seemed to be chronic severe inflammation going on. If I get told I have permanent nerve damage/brain damage that was most likely from what I believe it to be, what would constitute the doctors I saw falling below the acceptable standard of care? Does anything in my story so far seem like negligence from doctors?
Please feel free to ask questions, and apologies for the length of my post.

After being on Parnate for 5 months, I have decided to start tapering the dose (I am on 60 mg). With either the goal to see how I go with 30 mg - 40 mg only, or to stop it altogether. This will depend on if certain side effects go away and if it does anything for me.
Unfortunately, it hasn’t done anything for my depression or my anxiety. At best, in the beginning and only occasionally (not so much now), I had some mild improvement in terms of energy and motivation, but that’s really about it.
I tolerated it very well (better than ssri, snri, tricyclics etc), until I got to about 40 mg (which was ~10 weeks in), and then I really started to notice particular side effects. These side effects include:
• Exacerbated acne • Hair shedding
Up until I got to 60 mg, I really hadn’t experienced insomnia any more than usual. But once I got to 60 mg, falling asleep became incredibly difficult and seemed to take forever. Even with Clonidine. Prior to 60 mg, my insomnia was no different to baseline.
Also, once I got 60 mg, I started experiencing a pale coloured discharge from my penis, occasionally when I used the toilet. This discharge is followed by pain down below for about 30 mins. I have had this issue on some other antidepressants, too.
And my angeirritability seems to be a lot worse on 50 mg / 60 mg, the same goes for my OCD. My OCD symptoms seem to be a bit more pronounced.
While I have experienced rather pronounced postural hypotension the entire time, because I increased my doses slowly, it really wasn’t an issue and for most of the time, it is asymptomatic. Occasionally I do get those classic postural hypotension symptoms, especially if I am active. I did experience post dose hypertension a few times, which is not pleasant, but thankfully it was only something that happened mostly at the start. I would take 10mg Propranolol when this happened.
Brain zaps are an issue for me on Parnate, if I am an hour late with my first dose, my body knows it and I get brain zaps, excessive sweating, vivid dreams etc. And yes, I’ve tried to play around with dose times and it doesn’t make a difference. Sometimes I get brain zaps before I am even due to take the tablet!
The main reason I want to taper the dose now is because it just hasn’t been a success for me and I am very concerned about how much my hair is coming out and also my acne, and this does seem to be something that some people experience on Parnate.
The positives are that Parnate hasn’t caused any weight gain and my sexual function is almost as it would be off Parnate, except for some mild ED. I also had no issues with Tyramine or other medications, it is so important to have up to date information on these two concerns.
*** This is my own experience, please don’t be discouraged or put off. I am diagnosed with treatment resistant depression and agoraphobia, anxiety, OCD, tried 30+ meds in the last 9 years including all other Maoi’s, psychotherapy, ECT ***

{20F taking montelukast xyzal (allergies) lexapro lamictal caplyta (schizoaffective bipolar type) and depo shot.} I recently had a transabdominal and transvaginal ultrasound to investigate severe period pain and extremely irregular cycles. The ultrasound found a mass about 0.6 cm in size in my uterus. Notes describe the mass as hypoechoic and heterogeneous. Prescribing doctor (didn't perform the ultrasound) told me the ultrasounds showed nothing that would cause any of my symptoms and that I must have a GI issue. I don't believe her and neither does my primary. I'm going to see a better rated gynecologist to discuss the results. Being a current medical field student I was curious if the mass is something to worry about? Or is it too small likelihood at my age to worry that this mass is malignant?

I'm a 45m. Neuro thinks I have a combination of absence seizure and focal impaired awareness epilepsy where I stare without responding for a minute or two, then there is about 15 minutes of limited responses, if I do respond to questions its often one or two words. I've had several EEG scans that show no issues, CT scans to determine if its a stroke show no issue, cardio says my heart is doing great, nothing else shows any issues. I do have a TBI from 28 years ago from a car accident and have had no issues other than migraines from time to time. That was until april 2022.
Below is my log of episodes and sleepwalking as I've kept detailed notes trying to find commonalities between the events.
2022 2022 apr x1 episode 2022 may x3 episodes 2022 sep sleepwalk 2022 oct x2 episodes 2022 dec x2 episodes
2023 2023 jan x1 episode 2023 mar x2 episode crashed my car during an episode 2023 apr x1 episode start keppra 2023 may x1 episode 2023 sep x1 episode 2023 oct x1 episode (no episodes since) change from keppra to lamictal 2023 oct x2 sleepwalk 2023 nov x2 sleepwalk
2024 2024 jan x1 sleepwalk 2024 feb x3 sleepwalk 2024 mar x2 sleepwalk 2024 apr x2 sleepwalk 2024 may x1 sleepwalk change from lamictal to lamictal xr about to start zonegran
Neuro says I can legally drive since it's been over 6 months since my last episode and she does not consider sleepwalking the same as having an epilepsy episode. She says she'd be comfortable riding in the car with me.
I've been asking people if they would feel safe riding in the car with me and it's about 70/30 in favor of riding in the car. Some make jokes like, I'll ride in the car with you but I won't be on my phone that's for sure.
I work 4 miles from my house. I'm considering buying a small car such as a manual transmission miata just to go from work and home, perhaps to the grocery store and home, or to a doctors appointment and home. My thinking is, if sometimes does happen, a smaller car would cause the least amount of damage to someone else driving. You could say if that is a concern then I shouldn't be driving which is a fair statement to make.
I had one friend say I would ride in the car with you if you feel comfortable driving. The problem is, I don't remember any of the episodes. I only know about them because other people told me about them or I saw them on video. To me, I have no fear of driving, no knowledge of the events, but I also don't want to hurt anyone else else on the road nor myself.
My doctor says I can legally drive. I think I feel comfortable driving.
The question is, should I be driving?

Getting Started
by Peter Kolb
While the Buteyko method introduced into the west has been getting excellent results, it does not entirely accord with Professor Buteyko’s recommended practice. During two weeks he spent in New Zealand in December 2000, he demonstrated the Buteyko technique as it should be practiced.
Aim
Firstly, it needs to be understood that breathing too much is a bad habit that leaves you with a debilitating shortage of carbon dioxide and bicarbonate. It usually results from long term, undischarged stress. Any stress makes you breathe more. If this is sustained over a long time period it becomes a habit. The physiology behind this habituation process is well understood. Buteyko therapy aims at reversing this, by habituating to less breathing. You do this by developing and sustaining a feeling of a slight shortage of air over a long time period. This gradually restores your carbon dioxide and bicarbonate levels back to normal.
Maximum Pause
While it is possible to stifle an asthma attack with a long and uncomfortable breath hold know as a maximum pause (MP), this procedure does not reverse your asthma and does not retrain the respiratory center to pace your breathing correctly. Professor Buteyko is emphatic that the maximum pause has no therapeutic value in restoring healthy breathing, which is the aim of his therapy. It is also dangerous for people with various disorders such as hypertension, heart disease, epilepsy, kidney disease and diabetes. It can also destabilize your breathing, making it worse. Unfortunately the maximum pause has been introduced into a westernized version of the Buteyko technique, much to the annoyance of the Professor.
An understanding of the physiology behind the Bueyko method leaves no doubt that the maximum pause cannot improve your breathing.
DIY/Self-help
Professor Buteyko is firmly opposed to the DIY/self-help approach. The Buteyko technique relies 100% on patient compliance for effectiveness. Learning it from a script is like learning Yoga or martial arts from a book. Most people will experience changes in their bodies as their CO2 levels rise. These changes vary from one individual to another. Buteyko practitioners help you deal with these changes, keep you motivated and ensure that you do the breathing exercises correctly. Support for your Buteyko practitioner enables him to continue his work of bringing the technique to other sufferers.
Nevertheless, very few people around the world have access to a Buteyko practitioner. So here are some basics to help get you started.
Medication
Do not make any changes to medication. Steroids must be taken as prescribed. Because of carbon dioxide shortage asthmatics often don’t make enough Cortisol (natural steroid) and must have supplements. Steroids are not just anti-inflammatories but they are needed by the body and without the right amount it can be almost impossible to get breathing back to normal. Your doctor will be able to review your need for steroids when you stop having asthma symptoms.
Bronchodilators must be taken only when needed. As you progress, discuss with your doctor the possibility of weaning yourself off long acting bronchodilators and replacing them with short acting ones. That will give you more control over using them when needed. You should find that within days you will be able to overcome asthma attacks with reduced breathing and won’t need the bronchodilators. Nevertheless, you must always carry them with you for emergencies.
Nose breathing
Always breathe through your nose. If your nose is blocked perform the following exercise: After breathing normally (do not make any exaggerated breathing manoeuvre), hold your breath for as long as is comfortable, and then gradually resume very gentle breathing. It may help to pinch your nose, nod your head a few times or do some other form of exercise. In stubborn cases or when the blockage is due to a cold, you may have to try a few more times.
To avoid breathing through your mouth in your sleep, you might like to experiment with a little light medical paper tape to keep your mouth closed. Mouth taping at night is not recommended by Professor Buteyko, but most people find it extremely valuable. If you do, protect your lips with suitable cream, use a low tack tape (some are quite aggressive), and make sure you fold a tab or handle at each end for rapid and easy removal. Do not go to sleep with tape on your mouth if this causes any form of anxiety.
Comfort
Make sure you’re comfortable before starting the exercises. Remove unnecessary clothing since the improved blood carbon dioxide will dilate blood vessels in the skin, thereby warming you up.
Posture
To get your posture right stand with your back to a wall, heels, shoulders head and bottom touching the wall. Now drop your shoulders. Keep this upper body posture when sitting.
Relaxation
While maintaining your posture, relax all the muscles in your chest, neck, shoulders, arms, tummy and particularly the diaphragm. It’s a good idea to tense them up a bit first before relaxing them so that you can properly identify them and make sure they are all relaxed.
Normal Breathing
Take off your shirt and stand in front of a full length mirror. Watch your chest and tummy for breathing movement. Make sure that your chest does not move at all, and only the upper part of the tummy moves, between navel and breast bone. The second thing to check for is that the tummy moves out with each in breath and not the other way around. Many people get this wrong. Your out-breath must be free, relaxed and unforced.
Reduced breathing (RB)
Your aim is to develop a feeling of slight hunger for air, sustain this over a period and do this frequently. In fact, this should become a habit so that you do it all the time until you have achieved your health goal.
Try to feel your breathing and become aware of your breathing pattern. Now try to maintain this pattern while taking in just a little less air on each breath so that you develop a slight hunger for air. Initially try to sustain this for two minutes, then five and then ten.
If you follow all the steps correctly, then you should feel really calm, good and even a little sleepy. If you already practice relaxation techniques, yoga etc, you can combine them with reduced breathing.
Measuring your breathing
Hyperventilators breathe more than normal in order to achieve lower than normal blood carbon dioxide levels. It follows that if you have to breathe more than normal, then you will also not be able to hold your breath as long as you should. Professor Buteyko has cunningly used this principle to measure your blood carbon dioxide by testing how long you can hold your breath.
You start the pause somewhere in your normal breathing cycle. This is how you start the pause: Look up with your eyes and at the same time pinch your nose and start a stop watch. Just before it starts to get uncomfortable, stop the stop watch and resume normal breathing. You should be able to resume normal breathing without any effort and without taking deeper or more frequent breaths.
Some precautions:

• Do not take a deeper breath before the pause.
  
• Do not make any attempt to empty the lungs before the pause.
  
• Do not worry about which phase of the respiratory cycle you happen to be in before starting the pause. A pause is just an interruption of normal breathing.
  

The time in seconds is called a Control Pause (CP). Asthmatics typically have a CP of 5 - 15 seconds. (But not everyone with such a low CP has asthma.) Your aim is to achieve a CP greater than 40 seconds, although for perfect health Professor Buteyko recommends a CP of at least 60 seconds.
Doing a Set
When at rest, correctly seated, comfortable and relaxed and after breathing normally for at least five minutes you are ready to do a set. A set consists of
Pulse - CP - Reduced breathing - 3min normal breathing - Pulse - CP
First measure your pulse and then do a CP. Record the results on a table. Then do reduced breathing for ten minutes. Breathe normally for three minutes, then take your pulse again and take another CP. If you’ve done your reduced breathing correctly your pulse should go down and your CP should go up. Sometimes the pulse remains the same. If it goes up you’re not doing it correctly.
After three days you should be able to do around 8 to 10 sets a day. You can then start integrating reduced breathing into your daily life. Ideally you should aim at doing reduced breathing all day.
That takes care of the exercises. Here are a few helpful hints to help your recovery.

• Don’t eat unless you are hungry. Only eat until you have had enough. Eating increases breathing; eating excessively increases breathing excessively.
  
• Don’t dress too warmly. Be careful not to overdress children. If you are worried about them being cold, check their ears, nose, hands and feet. If these are warm, they’re OK.
  
• Make sure you get plenty of vigorous exercise. But don’t exercise to the point where you have to open your mouth to breathe.
  

If any of these recommendations make you dizzy, sick, anxious or give you palpitations, stop immediately. If possible see a Buteyko practitioner.

27 Female => Male Transgender
5'7 265lbs White/Romani
I have been waking up badly shaking and weak from deep sleeps since I was at least 7. Sometimes the shaking is so bad i can't get out of bed for risk of falling and hurting myself. It only seems to happen when I'm coming out of a deep sleep either naturally quickly coming out or being woken up by a person or alarm clock. I've noticed less frequency when i take 50mg or higher of Diamox before bed but can still happen. It feels almost like someone dumps ice water on me i'm shaking so bad and even if its warm in the house i feel ice cold.
Happening since childhood, around 7y of age.
I suffer with Idiopathic Intercranial Hypertension, Traumatic Brain injury (2012), Hypermobile Ehlers Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, Fibromyalgia, Psych issues (PTSD with psychotic features, generalized anxiety, major depressive disorder, borderline personality disorder, anorexia nervosa (been in recovery for 4 years)), Migraines, Balance issues, hearing loss, Irritable bowl syndrome, hypothyroidism.
Medications: Gabapentin 300mg 3xD, Diamox 500mg 3xD, Propranolol 120mg 2xD, Etodolac 400mg 2xd, Tylenol 1000mg 2-3xD, Lexapro 20mg 1xD, Lamictal 75mg 1xD, Benzotropien 0.5mg 1xD, Rexulti 3mg 1xd, Doxeipin 25mg 1xd 50mg 1xd, Claritin, Trigger point injections w/o steroids every 8 weeks, Testosterone i don't remember the dose math but its like half of a bottle 1xWeekly.
Use non-nic vapes occasionally, does not use Nic, or smoke cigs, drinks a glass or two of wine or a tequila sunrise once a month / every other month, 10 days clean from Marijuana.

does anyone else here take celexa and lamictal ? I use to be on it and never had a problem and I’m about to start taking it again but i saw that it can cause ‘hyponatremia’ wich is blood sodium levels getting to low and now im a little scared
i started back on lamictal and now im at 150mg And im restarting 10mg of celexa

does anyone else here take celexa and lamictal ? I use to be on it and never had a problem and I’m about to start taking it again but i saw that it can cause ‘hyponatremia’ wich is blood sodium levels getting to low and now im a little scared
i started back on lamictal and now im at 150mg And im restarting 10mg of celexa

does anyone else here take celexa and lamictal ? I use to be on it and never had a problem and I’m about to start taking it again but i saw that it can cause ‘hyponatremia’ wich is blood sodium levels getting to low and now im a little scared
i started back on lamictal and now im at 150mg And im restarting 10mg of celexa

does anyone else here take celexa and lamictal ? I use to be on it and never had a problem and I’m about to start taking it again but i saw that it can cause ‘hyponatremia’ wich is blood sodium levels getting to low and now im a little scared
i started back on lamictal and now im at 150mg And im restarting 10mg of celexa

does anyone else here take celexa and lamictal ? I use to be on it and never had a problem and I’m about to start taking it again but i saw that it can cause ‘hyponatremia’ wich is blood sodium levels getting to low and now im a little scared
i started back on lamictal and now im at 150mg And im restarting 10mg of celexa

I (23 F) for the past month have suddenly been super constipated. Before that I pooped like 3x a day and now it’s like a constant battle and so painful. I drink so much water, exercise, take fiber supplements, and still nothing has changed. I’ve never had this issue in my life! I have no idea what caused it or what to do. I’m on Wellbutrin, Lamictal, and Vyvanse but I’ve been on them for years and never had this problem before. Does anyone know what could have caused this / have any tips?
UPDATE: prune juice is no fucking joke

I haven't taken my mood stabiliser (lamotragine/Lamictal) in a few days because I can't afford my prescription. (I have zero $ to my name)
I am assuming this is the cause of my extreme low mood right now but I'm scared that after I get paid (late tonight) it will be too late and I will procrastinate picking my meds up tomorrow.
I experience this cycle extremely often, especially with my dexies because I have ADHD and when my symptoms aren't in control I cannot physically make myself do something that I know is extremely important.
It's like the urgency of the task is making me avoid it.
Does anyone have some advice on how to prevent this from happening/how to motivate myself to go get them tomorrow?

Hi everyone!
I'm sorry for the long post, I can't believe I've found this group but it might be some light at the end of the tunnel. I have a new neurologist scheduled but I think there's a big chance I might have intracranial hypertension maybe caused by hypothyroidism/levothyroxine.
So my story is this: everytime my doctor slightly changes my synthroid (levothyroxine), I miss a dose or I don't take my med on na empty stomach, the days that follows is like hell breaks loose and I have the following head symptoms: Sudden burst of pain around my neck that goes up my head. Then it starts: brain fog/difficulty concentrating and reading/memory is not perfect, a little bit of a headache, light and sound sensitivity, eye floaters, tinnitus (for one day or two when I lay down), nausea.
This last time I had it was really scary because I felt a little bit of disassociation and agitation also on the first 5 days. It appears in the morning, around 9am, and it goes away around 5pm. The front of the head does not hurt, neither does my eyes. Been to the hospital 2 times, I was medicated but several medications would not touch the problem. The whole thing lasts for about 10 days then goes away.
I told this this to several doctors, including 2 endocrinologists, and they all look at me like I'm crazy and have no idea what I'm talking about. 2 neurologists labeled as migraines. But if you look at syntroid's leaflet you'll find: intracranial hypertension. And then you search for medical reports and you'll find: https://pubmed.ncbi.nlm.nih.gov/25266827/ https://www.sciencedirect.com/science/article/abs/pii/S109185311400442X https://journals.lww.com/indjem/fulltext/2023/01000/idiopathic_intracranial_hypertension_following.3.aspx
I wanted to know if maybe my symptoms could correlate to intracranial hypertension and if anyone with hypothyroidism has gone through this.