Height: 1.87m
Weight: 87kg
Age: 31
Sex assigned at birth: male
Geographic region(s) your ancestors are from: born in Kyrgyztan (mother an father were born there), genetic test says 48% Eastern Europe, 32% Baltik, 10% England, 6% Central Asia and 3% Inuit. Grandma of my mothers side was orphaned, don't know anything about grandpa besides their wedding place in Kyrgystan. Grandma of my fathers side is from northern Russia and my grandpa from northern Germany/Netherlands.
Medications: -
Simplified Symptoms list: Blood pressure averages at around 175 systolic, 99 diastolic. Sometimes it goes up to over 190 systolic pressure, even when I don't feel anything off despite some, but not bad weariness. Also I suffer hyperhirdosis; I noticeably sweat more and more easily than others. Bad sleep.
Health background : Nothing protruding. I had repeated encounters of dog bites with puntured skin during my childhood, once on my head. Had chickenpox as a joung child and scarlet fever as a child. I live in areas with many ticks, which can transfer diseases. I had multiple ticks stuck on me during my lifetime, but not once a prominent infection. I tended to have regular middle ear infections due to having longer hair in my youth and going out into the cold winter with wet hair. Had multiple bones broke, most remarkably my left clavicle which was not 100% aligned to grow together.
I made a full run of experts: • Nephrologist • Radiologist • Cardiologist • Blood screens Result: nothing, except my right kidney seems to have split arteries connecting it to my aorta, but the doc said both diameters together should average to normal blood flow. The blood screen results pointed to a slightly hightened but not alarming result of the enzyme that points to the kidneys. (I forgot what it was called, sadly). I took blood pressure medication myself once but stopped as I wished to tend to the cause and not treat the symptoms. But a healthier lifestyle seemed not to help me...
Background of Symptoms : High bloodpressure was first detected when I was around 16 when I messured just for fun. Back then it averaged at about 155 systolic pressure.
Family history: My mother is taking blood pressure medication and my grandma (mothers side) has hightened blood pressure as does my grandpa(fathers side). They are old and seem to get by with it well, except my mother. She has a unhealthy style of life and cannot handle stress very good. Father had diabetes.
Other information: I exerecise regularly by going for runs, swimming, bouldering among other sports. I have a great variety of sports and do mostly cardio but also calisthenics. I stretch and use blackrolls for tensions in my muscles. I had long-term ECG device not too long ago. The results said I had a great range between high pulse and low pulse. BUT it detected sleeping apnoea. And indeed I go weeks of bad sleep before I am reminded by some wonder, that sleep can be restful. I eat vegetables or fruit to every single meal and try to mix it up regularly. Nuts, different grain, fish and meat is on my menue and I also take Vitamin D and Vitamin B12 and sometimes Magnesium supplements. I don't smoke and don't abuse any substances, though I consume alcohol and the occasional hash cookie. I drink one coffee per day and don't use much salt. I get my regular walks and during sunny days go into the sun. I meditate from time to time and have a supportive partner. In my mind I life way healthier than the average person but my energy level and motivation seem to be always way too low.

I have PCOS and am about to do my third treatment on my chin. The bumps and uneven skin tone is starting to make me look like I have a 5 o’clock shadow even worse than before I started! What should I use for this? I use cerave cleanser and moisturizer, the only other products are Paula’s choice salicylic acid in the am and vitamin c serum in the pm.

Mast cell activation syndrome (MCAS) is the subject of heated debate. How are mast cell activation syndromes defined? Which diseases are included? What is the diagnosis and treatment of mast cell activation syndrome? Prof. Dr. Knut Brockow, Clinic and Polyclinic for Dermatology and Allergology at the Biederstein, Technical University of Munich answers these questions in an interview with MeinAllergiePortal.
Mast cell activation syndrome: The most important facts!
-The prototype of mast cell activation syndrome is recurrent anaphylaxis
-Other forms of idiopathic mast cell activation syndrome are being sought; however, there are mainly symptom descriptions where the diagnosis cannot be made
-Clinical suspicion of MCAS is based on recurring allergy-like symptoms on the skin, nose, respiratory tract, gastrointestinal tract and circulation
-The diagnosis of MCAS is made according to recognized international criteria based on three criteria
-MCAS is often suspected even when symptoms are inappropriate and the diagnosis is unclear; the suspicion is then not helpful for patients
-The same medications are used to treat MCAS as are used to treat allergies, in particular antihistamines and cromoglicic acid
Prof. Brockow, what kind of disease is MCAS?
Mast cell activation syndrome is not an established diagnosis, but rather a concept. Historically, this concept arose because an increasing number of patients came to the doctor's office with complaints that gave the impression of having been triggered by mast cells. These patients sometimes showed symptoms similar to those of allergic reactions, anaphylaxis or mastocytosis, but a clear diagnosis for these diseases could not be made. Nevertheless, it was suspected that there could at least be a connection with mast cell diseases. Unfortunately, the term MCAS created more uncertainty than understanding. This is because MCAS is now thrown around as a diagnosis for many patients with many symptoms and an unclear diagnosis. This is not helpful for patients and fuels short-term hope of diagnosis and cure, which cannot be fulfilled later.
Is MCAS an autoimmune disease?
No, in autoimmune diseases mast cells are not primarily involved and not as lead cells, but lymphocytes that attack the body's own structures, in some cases by forming antibodies.
Is there a connection between mast cell activation syndrome and autoimmune diseases?
No, there is no known connection between MCAS and autoimmune diseases. It has also been claimed by specific authors that other diseases, such as Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are related to mast cell activation syndrome. However, there are no good arguments for this. Unfortunately, such claims are easy to make and difficult to refute.
What is the cause of mast cell activation syndrome?
Mast cell activation syndrome is actually more of a symptom description than a diagnosis in its own right. Mast cell activation syndrome is fully applicable to recurrent anaphylaxis (severe allergic reactions in several organ systems such as the skin, respiratory tract, digestive tract and circulatory system), for example due to insect bites. All the criteria for mast cell activation syndrome are met here. Severe allergic reactions are the most common cause of MCAS. However, although the term MCAS is correct in this context, it does not provide any additional information, as patients with such events are better described as patients with a diagnosis of anaphylaxis or allergy, and the term MCAS is somewhat confusing.
Is mast cell activation syndrome genetic?
MCAS itself is not genetic, but patients with the genetic disease mastocytosis often suffer from anaphylaxis, particularly to insect venom, and therefore MCAS. In addition, it is currently being investigated whether people with genetically determined hereditary alpha-tryptasemia suffer more frequently from MCAS.
How did the term mast cell activation syndrome come about?
There were many patients without a clear diagnosis, some of whom predominantly showed the symptoms typical of mast cell diseases. Accordingly, the experts dealing with mast cell diseases saw the need to develop a concept that took into account the “undiagnosable” symptoms of the patients. In the course of this, the terms “mast cell activation” and “mast cell activation syndrome” were defined. In addition, an attempt was made to sort all mast cell diseases into a classification with regard to mast cell activation. However, the difficulty in classifying these complaints is that many of the complaints described by patients are subjective, relatively non-specific and can be both organic and psychosomatic.
How have you defined mast cell diseases and which diseases do they include?
Mast cell diseases are defined as recurring chronic symptoms that are compatible with mast cell activation.
Mast cell activation is classified on the basis of three criteria:
Recurrent typical clinical symptoms in at least two organ systems
An increase in mast cell mediators can be detected in the blood, most frequently by determining the serum tryptase level during an acute attack
Good response of symptoms to anti-mast cell mediator-directed therapy, especially H1 antihistamines
What types of mast cell disease are there?
The classification of mast cell diseases associated with mast cell activation syndromes defines three groups:
1. primary mast cell activation syndrome
Primary mast cell activation syndrome is explained by a clonal expansion of mutated overactive mast cells. It manifests as systemic or cutaneous mastocytosis. If these criteria are not completely fulfilled, but clonal mast cells have been detected, it is referred to as monoclonal mast cell activation syndrome.
2 Secondary mast cell activation syndrome
Secondary mast cell activation syndrome is present when clear triggers of mast cell activation are known. There are established terms for secondary mast cell activation syndrome that we are more familiar with, such as “anaphylaxis” to a known trigger. The classification in the second group of mast cell diseases is therefore merely a reclassification. Examples of mast cell activation are physical urticaria or cold urticaria. Allergies such as pollen allergies are also secondary mast cell activations, as hay fever also causes symptoms typical of mast cell diseases. In pollen allergies, mast cell mediators are found in the blood serum and drugs directed against mast cells have a good effect. If the symptoms recur in several organ systems, this is referred to as mast cell activation syndrome.
3. tertiary or idiopathic mast cell activation syndrome
Tertiary or idiopathic mast cell activation syndrome refers to mast cell diseases whose triggers are unknown. This group would include, for example, chronic spontaneous urticaria, which has additional symptoms in other organs. Here we know that mast cells are activated, but not by what. This group of idiopathic mast cell activation syndromes would also include patients with as yet undescribed clinical pictures who do not fulfill the diagnostic criteria of known mast cell diseases, e.g. allergy, anaphylaxis, but in whom the disease is triggered by mast cells. In these patients, however, the connection between the symptoms and the activities of the mast cells must be proven.
Does this mean that tertiary or idiopathic mast cell activation syndrome is a diagnosis of exclusion?
Idiopathic mast cell activation syndrome can be described as a diagnosis of exclusion insofar as the prerequisite for the diagnosis is that there is no other disease causing the symptoms. However, the symptoms described are often very, very unspecific and could also be caused by a variety of other diseases. However, there are the three criteria for mast cell activation syndrome already mentioned. If these are not all fulfilled, this diagnosis cannot be made.
How common is mast cell activation syndrome?
Anaphylaxis and severe recurrent allergies are not uncommon and represent the vast majority of appropriate cases for MCAS. In addition, mastocytosis patients often have multiple anaphylaxis and therefore also MCAS. However, our initial idea of finding a new disease, idiopathic mast cell activation syndrome, has not yet been confirmed. There are many patients with many symptoms for whom a clear organic diagnosis cannot yet be made. However, it is almost never possible to prove that a defect in the mast cells is primarily responsible for the symptoms. Many of these patients describe symptoms that could fit, and in some patients anti-allergic drugs also have a positive effect. But in only very few patients can an increase in mast cell mediators be detected during an acute attack. I now believe that somatic stress disorders could play a significant role in many of the patients examined.
Histamine intolerance is also a diagnosis of exclusion, is there a connection with mast cell activation syndrome?
Histamine intolerance can cause similar symptoms, but is not a mast cell disorder and has nothing to do with MCAS. When mast cells are activated, the messenger substance histamine is released, which in turn can cause symptoms. In histamine intolerance, the mast cell is not activated - it is not involved in any way. Rather, histamine intolerance describes patients with an increased sensitivity to histamine, which is supplied, for example, via the diet. This can lead to similar symptoms, but in contrast to mast cell activation syndrome, histamine intolerance has a clear trigger, histamine. As a result, the symptoms occur after eating histamine-rich foods, but disappear again if the patient follows a low-histamine diet. A test is also available to diagnose histamine intolerance.
So there are also patients with suspected mast cell activation syndrome who cannot be assigned to a classification group, even though they have corresponding symptoms?
There are many patients in whom no mast cell activation syndrome can be detected despite suspicion. They do not fit into one of the three groups. However, this also used to include monoclonal mast cell activation syndrome. These patients showed anaphylaxis and a KIT mutation, but not the full criteria for mastocytosis. In the meantime, a separate disease diagnosis has been created for these patients. The independent accepted disease of these patients therefore lies between mastocytosis and normal findings.
We thought that there might be other forms of idiopathic MCAS with clinical pictures that have not yet been described. However, this is not supported by the findings to date. There are patients who show symptoms but do not meet the necessary criteria for idiopathic mast cell activation syndrome. In these patients, the diagnosis remains unclear. In how many of these patients functional physical complaints play a role still needs to be investigated.
Are there risk factors that favor mast cell activation syndrome?
There are hardly any recognized studies on this. In a study conducted by Cem Akin in the USA, patients were examined who met the three criteria for idiopathic mast cell activation syndrome. They had the right symptoms, there was an increase in mediators and their symptoms improved with treatment. It was shown that many of these patients suffered from urticaria factitia, a scratch-induced urticaria, abdominal pain and flushing.
Recently, a genetic trait was discovered, hereditary alpha-tryptasemia with elevated basal serum tryptase levels. In patients with this trait and insect venom allergy, the severity of the allergic reaction appears to be increased. It is also discussed that the frequency of mast cell activation syndrome is increased in patients with this genetic trait. However, the published studies are not yet unanimous in this respect.
What symptoms can occur with MCAS?
The following symptoms could be signs of mast cell activation syndrome:
MCAS symptoms on the skin:
Appearance of sudden intense redness (flushing)
itching
wheal formation
Deep wheal formation (angioedema or Quincke's edema)
MCAS symptoms on the nose:
Nasal congestion
Nasal itching
MCAS symptoms in the airways:
Swelling of the upper airways
Wheezing
Shortness of breath
MCAS symptoms of the digestive tract:
Vomiting
abdominal pain
diarrhea
Systemic MCAS symptoms:
Syncope - where you suddenly lose consciousness, but only for a short time
Sudden drop in blood pressure
Allergic shock
These symptoms can occur together or individually. In principle, symptoms must occur in two or more organ systems for MCAS. These symptoms, together with the typical skin changes and anaphylaxis, are also typical of mastocytosis.
Are muscle pain and hair loss also symptoms of MCAS?
No, why would anyone think that these symptoms are primarily caused by a malfunction of mast cells? Mast cells are not important cells for muscle pain and hair loss.
How is MCAS diagnosed?
MCAS is a diagnosis of exclusion, i.e. there is no mast cell activation syndrome test. However, this does not mean that all other diseases must be ruled out before a diagnosis of MCAS can be made.
When testing directly for mast cell activation syndrome, three criteria would be examined, all of which must be met, not just two:
First, there must be a matching of symptoms to see if the above symptoms are leading, recurrent and occur in at least two organ systems.
Is there a substantial or complete improvement in the clinical symptoms when taking anti-allergic medication, antihistamines or cromoglicic acid? Then this criterion would apply.
The blood levels of tryptase in the serum can now be examined at two different points in time. This would check whether there is an increase in mast cell mediators or tryptase in the blood serum in a highly symptomatic phase or during a seizure compared to a time when there are no symptoms.
What does the tryptase level in the blood mean in the diagnosis of mast cell activation syndrome?
If the mast cell mediator tryptase rises by 20 percent of the basal value, i.e. the initial value, + 2 ng/ml during such an episode, the diagnosis of mast cell activation syndrome has been made without the need to rule out other diseases beforehand. However, taking blood samples to determine the tryptase levels is very time-consuming, because a blood sample should be taken in the normal state and then another blood sample should be taken during a seizure or a highly symptomatic episode. This means that the patient must see a doctor in good time for a blood test during the acute phase. If these tests are negative, mast cell activation syndrome cannot be confirmed.
Elevated tryptase levels also play a role in anaphylaxis, is there a connection with mast cell activation syndrome?
Anaphylaxis is an extremely strong mast cell activation, the “prototype” of mast cell activation, so to speak. The tryptase level rises, so that it is considered an indicator of anaphylaxis. Here too, the basal value is measured and compared with the value during an episode. The relevant factor is the resulting increase in the tryptase value. The therapy against mast cells is effective in this case. In this respect, anaphylaxis is the classic form of mast cell activation syndrome.
The tryptase value also plays a role in the diagnosis of mastocytosis, what are the correlations here?
Mastocytosis patients also have an elevated baseline tryptase level. This is therefore an indication of mastocytosis and an indication for a final diagnosis by means of a bone marrow biopsy. However, there is also a mastocytosis-independent correlation between tryptase and anaphylaxis. People who have a higher number of mast cells often develop more severe anaphylaxis than people with fewer mast cells. The tryptase basal value is therefore considered a kind of indicator for the total mast cells in the body. For example, insect venom anaphylactic patients with elevated basal mast cell tryptase levels in the blood are at increased risk of severe anaphylaxis.
What can be done against MCAS and which medications help?
The aim of treatment for mast cell activation syndrome is to slow down the effect of the overactivated mast cells and to calm the mast cells. In particular, the avoidance of allergic triggers is available for this purpose.
Histamine receptor blockers are tried as medication to block the effects of mast cell activation by histamine. Mast cell stabilizers or blockers of mast cell release, cromoglicic acid, can also calm the mast cells. Cromoglicic acid is also used in mastocytosis patients. It is important to know that the use of cromoglicic acid is not advisable if the attack has already run its course. On the other hand, many patients achieve a significant improvement in symptoms if cromoglicic acid is taken continuously as a preventive measure and in a sufficiently high dose. This has also been shown to be the case with antihistamines.
Another option would be leukotriene receptor antagonists and corticosteroids in the short term, but never over a longer period of time.
Unfortunately, many patients with previously unexplained complaints are given a suspected diagnosis of MCAS in the hope that this knowledge will lead to better treatment or perhaps a cure. However, apart from the drugs mentioned, which can also be used on a trial basis in cases of suspected MCAS, there are no other useful drugs available. In this respect, the suspicion of MCAS unfortunately does not offer patients any additional treatment options.
Are there foods that activate or deactivate mast cells?
No such foods are known in humans. Of course, it is possible to bombard mast cells in a test tube with high concentrations of food and measure whether the natural activation of mast cells is increased or reduced. However, such tests are generally not meaningful for humans when consumed.
Can naturopathy help with mast cell activation syndrome?
I don't know how it could help. Naturopathy is the attempt to achieve a positive effect through naturally occurring active substances. Is the avoidance of allergens in our natural environment already naturopathy?
Could certain vitamins, for example vitamin C, be beneficial for MCAS?
This is claimed by a few doctors without any convincing results. Vitamin C is also said to help against seasickness. After all, vitamin C, taken in normal amounts, is not harmful and is beneficial. Sometimes the conviction that a substance is good for you also helps. That's why the experiment doesn't bother me.
Is it possible to prevent mast cell activation syndrome?
Yes, by avoiding MCAS with a known trigger. This is the case with allergies. In the case of allergies and recurrent anaphylaxis as a form of MCAS, omalizumab, an antibody against immunoglobulin E, can also be used in individual patients.
Prof. Brockow, thank you very much for this interview!
https://www.mein-allergie-portal.com/mastozytose-mastzellaktivierungssyndrom-mcas/925-idiopathisches-mastzellenaktivierungssyndrom-ein-neues-krankheitsbild.html

TLDR: I'm in nursing school and realized I used to misunderstand nurses. They weren't condescending when they explained things in such basic terms to me; they were thorough to ensure everyone understood them. I used to get frustrated with their explanations and follow-ups, but now I see the value. It's about making patients feel comfortable and informed. I still wonder if scheduling so many follow-ups is the best approach, but I understand the thought process. We're all just trying to take care of patients and make sure no one feels dumb. Ironically, it's kind of the opposite of being condescending.
I'm in nursing school right now. The patients we get to work with in clinicals are a lot like the patient population at the hospital where I used to go when I was younger. Sometimes I'm still a patient there too. My insurance hasn't changed.
Before nursing school, I used to get frustrated with how the nurses would talk to me in primary care. They weren't mean or anything, but I felt like they were underestimating my intelligence, you know? Sometimes I even got a bit sassy with them. I know they had thick skin, but I totally regret that behavior now. If I could send them an apology card, I would.
They'd say things like "bring all your medications to the next appointment." And I'd be like, "but why? can't I just tell you what I'm taking?" Then they'd explain they need to know the dosages too. And I'd say "well I can tell you the dosages too, can't I? 🤷‍♀️ I can even bring a picture if you want me to."
And then they'd say stuff like, "you need to be fasted for this blood test. That means no eating or drinking anything. Water is okay, but no juice, milk, coffee, nothing like that." And in my head I'd be like "yeah, I know what fasting means 😂"
But the most frustrating part was all the follow-up appointments.
My parents weren't super punctual with making sure we did a physical every year to be honest with you. So every time I did a physical, I was usually due for routine bloodwork. Like literally right at the end of a physical, the nurse would schedule another appointment for me to come back and discuss the test results. Now that I see things from their side, I know they do this with everyone. One time, I even left school early for the appointment and the nurse just explained to me:

"The doctor wants me to go over your test results with you. Let's start with the lipid panel. Cholesterol is a kind of fat that's in your blood. We all have some of it. It's a problem if someone has too much. There are different kinds, like LDL and HDL. When we did your blood tests, they scanned the blood to see how much cholesterol was in it. Like I said everyone has some cholesterol in their blood. You don't want too much. Your levels were normal. So that's good..."

And she just kept going on and on through every test result, telling me that they all came out normal. Then she said my vitamin D was low and gave me a long explanation of what that meant, how it was not super serious, and how they were giving me more vitamin D to take.
I got so frustrated that day because the whole thing could have just been a notification on MHO saying my blood test results were normal. Maybe it could have been a phone call at most to explain the Vitamin D part. I thought that's all it needed to be. For me to take time off school to go to the doctor for this felt like a huge waste.
I still don't know if those follow-ups are the "best" way to do things, but I can understand the idea behind it. On one hand, it made sure that patients could really understand things. Not every patient would have felt comfortable accessing information through MHO and relying on their general knowledge to understand test results. I'm not trying to be demeaning at all, but not everyone has the same background. But on the other hand, scheduling so many follow ups made those wait times longer and made it harder for people with issues to get seen. It was kind of a double-edged sword, you know?
The nurses were just trying to make sure everyone understood, even if it felt a little condescending to me at the time. But now I can appreciate that so much more, you have no idea!
Oh, and one other thing I learned from a preceptor was they make a point to assume the patient has zero background knowledge so that they don't embarrass any patients. Going back to that cholesterol example, we're not supposed to start with telling patients about their LDL and HDL levels right away. We need to start with explaining what cholesterol is first and take it from there step-by-step, just like a nurse once did with me. The idea behind that is to not embarrass patients who don't know something, you know? You don't want a patient to be like "uh... what is this girl talking about LDL and HDL... and what is cholesterol again? but i won't ask because i don't want her to think i'm dumb." It's about making them feel comfortable.
I also know nursing school clinicals are different from other settings. I know not every nurse has time to explain everything to patients.
In the more fancy schmancy clinics which only take private insurance, I have no clue what it's like. When the patient population is different, maybe the nurses talk to patients differently too? I literally have no idea. But I'm just trying my best to understand where everyone is coming from. I think we all want to be sensitive to people's needs and help them feel heard and understood. I never want anyone to feel dumb or embarrassed. We're all just trying to take care of each other here. I'm rambling again. Anyways, that was like a lightbulb moment since a lot of things started making sense to me. I just wanted to post it here. I know this was long but thanks for at least skimming it. Muah 💋

Vitiligo is a skin condition characterised by the appearance of white patches. Dr. Shikha Aggarwal, a renowned dermatologist for vitiligo treatment in Ludhiana, says that vitiligo can affect any part of the body, and the majority of sufferers have multiple white spots on their skin. Millions of people around the world suffer from vitiligo. Anyone can be affected, regardless of age, gender, or race. Vitiligo can affect a person's mental and emotional health, even if it is not a contagious or life-threatening disorder. We will learn about the top treatments for vitiligo in this blog.
What makes one more vulnerable to Vitiligo?
The exact cause of vitiligo is unknown. Many vitiligo sufferers have no family history of the condition, and it does not appear to be inherited. However, having vitiligo or other autoimmune diseases in the family may increase one's susceptibility.
Vitiligo can be linked to a variety of autoimmune conditions, including:

• Thyroiditis, caused by an unbalanced thyroid
• Lupus
• Psoriasis
• Alopecia areata, or baldness
• Type 1 diabetes
• Pernicious anaemia, which is caused by a problem with vitamin B12 absorption
• Addison's illness
• Scleroderma, a connective tissue disorder, and rheumatoid arthritis

Furthermore, some doctors claim that vitiligo appears in the following:

• Serious wounds or sunburns
• Exposure to chemicals and poisons
• High-stress levels

Common Treatments for Vitiligo
Several treatments are available that can be helpful.

1. Phototherapy or Light Therapy: UVA light therapy, also known as phototherapy, can help slow or stop the progression of vitiligo. This is frequently combined with other medications prescribed by a doctor. This therapy is commonly administered several times per week in a doctor's office. However, portable medical equipment allows patients to receive care at home.
2. Excimer Laser: If medication does not work or produce the desired results, laser vitiligo treatments can be used. Laser-based vitiligo treatments deliver the expected results: they are effective. This technique restores the color of the skin by depigmenting it with a laser. The excimer laser has a wavelength of 308 nm.

Important Note
There are no home remedies for vitiligo. Always consult a specialist skin doctor for treatment advice. A skilled dermatologist will only recommend the most appropriate treatment after evaluating the condition. If one is looking for the best skin specialist in Ludhiana, one can consult with Dr. Shikha Aggarwal. She has been helping many vitiligo patients lead a normal life with her top-notch treatments.
To learn more, book a consultation with Dr. Shikha Aggarwal today.

Started having a skincare routine two months ago lang, di pa strict yun. My sister is an impulsive buyer so di na nya ginagamit yung garnier vitamin c set nyang binili nya. I only needed the basics at first so kinuha ko yung cleanser at sunscreen nya. Bumili ako ng celeteque moisturizer eventually.
The vitamin c sunscreen and cleansers felt off to me. I wasn't comfortable with the sting sa sunscreen and the cleanser felt too drying (may salicylic acid pala yun and di pa sanay ang skin ko). I ditched my ate's garnier products and started buying my own.
Eventually, nag-decide na rin ako bumili ng niacinamide serum (ibang brand), which i continue to use religiously. Bumili na rin ako ng ibang products na tinatarget ang skin concerns ko.
So last week, nakita ko yung garnier bright complete vitamin c overnight booster serum ng ate ko. I used it in my routine that night and went to sleep.
Pagkagising ko, grabeng smooth ng mukha ko! I have uneven skin texture sa forehead and cheeks ko, but when i woke up, it was as if i have makeup primer on. My face was oily upon waking up (which is normal for me) so inisip ko baka sobrang dami ng oil kaya naging ganun ang mukha ko.
I thought it was weird kaya i decided to forgo makeup that day. I kept touching my face that day kasi di ako makapaniwala. Could it really be due to the serum?
I went home that day and sabi ng ate ko, ganun din daw ang experience nya. 3 days lang may nakapansin na ng effects sa mukha nya. I decided to add the morning vitamin c serum too before niacinamide serum on my AM routine.
It's been 4 days since using vitamin c and it's still soft and smooth! Honestly, i felt cheated kasi i've been religious sa cleanser-toner-serum-moisturizer-sunscreen routine, tapos isang serum lang pala yung magpapakita ng instant and drastic effect sa skin ko.
Honestly, it feels like my skin has a film over it na nag-cover sa texture nito. The bumps are still there but they don't feel as uneven as before. I wonder if hindi long-lasting yung effects ng vitamin c serum na ito?
I'll still continue my new routine na nay dagdag vitamin c but i'm still kinda bummed lol.
[I've experienced naman na na may biglaang effect from a product. I over-layered Papa Recipe Blemish Peeling Toner once and then when it dried, sobrang plump ng skin ko. It turns out i overused it kasi when i put a serum over it, naging sticky yung mukha ko, parang glue yung nilagay ko. What remedied it was when i used a thicker product (sunscreen). Nawala na stickiness nya.]

Hi I am a 29Y female, brown skin. I have never had a routine before. I am just starting the routine skin care game. I have acne scars. I have combination skin. I am currently using Cerave AM PM moisturizers. I like the Pm but Am doesn’t go well with my skin is what I think. I am using Estee lauder gel moisturizer. I am trying to include vitamin C serum and AHA BHAs into my routine. Any suggestions for the routine along with product names please? It would be helpful if they are not very expensive products. Thank you in advance!

Curious to know what medications and supplements others are taking and what you’ve found the most helpful.
I currently take daily: Birth control (generic yaz) Metformin 1000mg Daily multivitamin Vitamin D (always deficient even with multi vitamin)
Not daily (because I’m bad at routines) but a few times a week I take ovasitol and L-glutamine. The latter is not totally for pcos but helps with ibs bloating and anecdotally seems to help with cravings.
I’m prescribed but not currently taking 50mg spironolactone. I have some excess face hair and experience really oily hair and body acne. Debating starting it again for those reasons but I struggle with muscle cramps and dry skin from it and am not sure I really need it.
I also have NAC supplements that I used to take before I was prescribed metformin last year. I plan to start adding NAC in again because I feel so inflamed and puffy and NAC seemed to really help with that in addition to helping some obsessive behavior and thoughts. I’m only nervous as I have seen a study that suggested NAC and metformin are effective on their own but have reduced effectiveness when combined. On the other hand I see so many people on pcos taking them together with positive results.
All together I often get supplement fatigue by trying to take all of these thing and monitor effects! That being said I am really struggling with my weight and pcos symptoms lately and am feeling desperate for some progress so feel like maybe it is all worth it. Does anyone else get overwhelmed with all the meds and supplements? What do you take and what works for you?

Warning - beware chance of [confirmation bias] and [placebo effect] in this post. Also note that I live in NORWAY, similar to ALASKA in terms of sunlight. This post may not apply to people in sunnier regions.
This (title) has been a main theme of my IF-journey since starting around 2005.
I am no scientist, but tanning has an extremely calming effect on me, and removing virtually all cravings, for a couple of weeks. Based on this I concluded that it must be low vitamin D that is the culprit... Sadly, I am in the highest skin cancer risk bracket (anglo-saxen + moles). So I try to tan the very minimum that lets me sustain this effect (2 x 15min. pr. month). Also, tanning beds are much more strictly regulated here in Norway (vs. US), and we don't get much sun to begin with due to latitude.
In order to produce similar effect with supplement, I had to go as high as 20kUI daily for several months. I ended that experiment though, because it seemed to cause a non-stop shingles outbreak in eye region (worst place you can get them). In terms of reducing cravings, it worked really well though, And that effect lasted for a year or so after I quit. (A single short tanning seems to 'wear off' in a couple of weeks.)
* * *
Am I the only person seeing this? Well no. Turns out, several research papers have hinted at this type of connection. To you want to verify, try highlighting the title > right-click > search. I will link a summary of the research, but please beware that this web page was created by 'vitamin D fans' similar to myself: https://vitamindwiki.com/Overview+Obesity+and+Vitamin+D
So, should you just start tanning? I would say no! Unless you have the time to carefully research how strong the tanning beds in your region are, and what the skin cancer statistics are in your area, and for your skin type.

This was created as a place to feel welcome, and to discuss and talk about all things TRT in Australia.
We have an influx of clinics opening up here, with an influx of new people to TRT, and it's only growing
(did you know GP prescribed testosterone has risen over 500% in the last 10yrs worldwide...)
Below is a breakdown of TRT, clinics and bloodwork.
TYPES OF TRT
There are a few methods of TRT in Australia and the world.
Injectable testosterone -- this is the standard type of TRT method with the most amount of research and usage to date. Typically injected Intra-Muscularly, but with more data showing that SubQ injections are just as effective and could potentially have lower side effects due to the slower release
Testosterone Cream & Gel -- Topical ointments can be great due to not having to inject weekly, daily etc, just apply and carry on, but, with topicals, especially Gel - the risk of transfer to other people is very high, you also don't know how much is actually getting absorbed into your skin, and generally you aren't allowed to swim for 6hrs post application
Enclomiphene & Clomid -- This tablet form of TRT has some popularity as it doesn't shut down your natural production and helps to raise it instead, it is also one step even easier than topicals but the overall effectiveness and long term use aren't fully understood and anecdotally seem to be less effective over time and may stop working.
HCG (Human Chorionic Gonadotropin) - another injectable form of TRT but instead of replacing the bodies natural production with an exogenous source, HCG will instead stimulate LH production, almost "forcing" the body to produce naturally -- HCG is often used alongside injectable testosterone to maintain testicular function and natural production
** Some people have success with all forms of TRT, but anecdotally, injectable TRT is still the king of testosterone.
CLINICS
If you are looking for a reputable clinic, below are some clinics that are recommended by Aussies;
PHC - Performance Health Clinic * No yearly or ongoing fees, a pay as you go service, with a more hands off approach + bloodwork every 3mths + cost of medication
EMC - Enhanced Mens Clinic *$1000 yearly fee + bloodwork every 3mths + cost of medication
Primal Zone *$350 initial consult, $100 bloodwork review + cost of medication
The Functional Doctors - over 40s clinic * Bloodwork every 3mths ($300 panel must be done) + $300 consults every 3mths + cost of medication
XY Theraputics - Over 40s clinic * Byo bloodwork or $210 in-house panel. Start up; $299=consult and blood tests $150=consult plus BYO bloodwork - ongoing costs $92 consult and review
TRT Australia * Yearly $860, Quarterly $240, Semi-Annualy $480 - Includes medication, bloodwork review (BYO blood), check-ins
PRIVATE BLOODWORK If you have a good GP that will do bloodwork, that can be a lifesaver, but if not, these companies are trusted and can usually have results within 24hrs.
iMedical * Recommended tests to get before starting your journey are Sports BB2 $172, BB3 $186, BB4 $248
RoidSafe * A smaller set of testing compared to iMedical, but for $50, you can get a snapshot of your bloodwork. This is perfect for patients who know how to read bloodwork and just want to monitor.
Things recommended to check before starting TRT or the journey to TRT;
Semen analysis - It's important to check your sperm health and count before starting as testosterone, sex hormones and your sperm all work closely together - and if you want to have children in the future; you absolutely need a baseline
Sleep study - A very large portion of men have sleep apnea that is directly linked to low testosterone levels, it's important to rule this out as it could be a large contributing factor to how you feel and what your levels show
Full blood panel - You're not just checking testosterone levels, you're checking everything, Vitamin D, Thyroid, Testosterone, Prostate. You need a full panel to be able to tell a full story. And even then, your lifestyle can tell an even bigger part of the story to what's on the paper in front of you.
It's important to remember that TRT can be life changing for a lot of men, but changing your life even the smallest bit can help just as much, as low T symptoms can be caused by a plethora of other illnesses or issues and you need to rule out everything you can;
TRT is generally a "for life" dependant medication; meaning if you have low T and you want normal testosterone levels, you will need to be on TRT for life. You can come off at any time, but you will go back to the original baseline levels you had before starting, and in some cases, go back lower than baseline.

Two weekends ago my husband and I went out of town and when we returned, noticed that our ~11 year old DSH/Russian blue cat was slightly limping on his front left leg. We asked our trusted cat sitter, who comes 2x a day when we are gone, and she said she hadn't noticed any limping but said he did seem more stand off-ish than usual. We figured he might have just landed on it funny and decided to keep a close eye on it. The limping would stop for a day or so, but then return, and we also noticed that he was laying on the hard wood floor a lot, which is unusual for him, so we took him in to our vet.
The vet suspected a sprain or arthritis and said they would do some x-rays to be sure. After sedating him, she did a more thorough exam (he is always very spicy at the vet) and we were both SHOCKED to discover extensive and pretty severe bruising all over his left side. The vet said she had only seen this level of bruising previously with cats who had been in a severe trauma. She spotted some through his fur and then shaved him to get a better look. We were absolutely stumped as our cat is 100% indoor, and while he does have a younger and more spry sister that he occasionally plays and wrestles with, she is completely deferential to him and their play sessions never end in so much as a hiss.
We decided that he must have somehow gotten caught in something, or fallen down our stairs, but honestly were still stumped as to how this happened. The vet put him on some pain meds and said to keep a close eye on it.
The bruising hasn't really gone down and now we're noticing more swelling and purple spots under the skin on his back left paw. Even if something traumatic did happen to him the weekend we were gone, he has definitely not had anything new happen since. Our vet is completely stumped and we are about to take him in to urgent care, but eager for any and all thoughts on what this could possibly be. I have photos but some how not allowed to upload them here.
His only other medical issues are IBD (diagnosed ~2 years ago, treated with Rx food, a low dose of prednisilone and vitamin B injections) and cardio myapothy (diagnosed ~2 months ago, given a cardiac supplement and daily enalapril to treat). He got a full ultrasound 2 months ago for his cardio appointment and full blood work then and again during his most recent X rays and the vet didn't see anything that could be causing this. He is slightly anemic and white/red cell counts are slightly off, but nothing that she would consider out of the ordinary for his other issues.
UPDATE: After more blood work tonight he is very anemic (red blood cells at 18%) and abnormal clotting. Will likely get a blood transfusion overnight to stabilize him enough to run more tests.
Age: 11
Sex/Neuter status: neutered
Breed: DSH/Russian Blue
Body weight: 10.8
History: Above
Clinical signs: Above
Duration: First noticed April 28 - limping has improved but brusing has not
Your general location: east coast USA

I’m on year 7 of my IC journey that started at 15 years old. I’ve had pretty much everything under the sun with multiple specialists, so I thought I would share for people in the same positions I was in during the beggining.
Regular gyno or urologists are oftentimes clueless about IC. Please see a urogyno asap.
Hydroxozine and Benadryl can help with the bladder sensitivity and burning a bit as well as help you sleep.
If you’re looking for something non drowsy Zyrtec may work for you and one of my friends has really good luck with Xyzal (both are otc).
There are some studies about the long term effects of too much Benadryl so I’d be cautious about that.
Some supplements that many people with IC take consistently are D-mannose, aloe tablets, magnesium (for the muscles and sleep), and marshmallow root. I’ve noticed improvement from D-mannose and aloe for the burning but not as much marshmallow root.
The aloe tablets are also great for those with vaginal dryness from their inflammation.
Desert harvest also has an AMAZING cream called relevium you can order over the counter with 4% lidocaine in it as well as aloe and vitamin e that helps repair skin and reduce inflammation. It’s so good for the burning. Do not use it inside (but a little won’t hurt if it gets in there). It’s mainly for urethra irritation and burning.
IC is not simply a bladder disorder originating from inside your bladder. It HEAVILY affects your muscles. Feel inside your vagina and if it’s very tight, banding, or causing painful intercourse you likely have hypertonic pelvic floor issues either causing or exacerbating your IC. There are many stretches you can do to help this as well as pelvic floor therapy. It’s a godsend for many, but don’t get discouraged if it gets a little worse before it gets better with that. It’s part of the process with the lactic acid build up in your muscles.
There are two common kinds of PFT one of which you should be very wary of. The first time I went through this process I saw a team who focused on electrostimulation therapy. This is where a probe is inserted vaginallty and anally and contracts the muscles more and more with each visit. That method also focuses on kegals. Not only does it make most people much worse while they’re in treatment, it’s proven to not be very effective at all and make some people worse. The goal of this method is to essentially wear out your muscles to the point they finally give up and relax. It’s effective for very few people and I would suggest only doing it as a last resort.
I would recommend pelvic floor therapy involving muscle relaxers, stretches, and vaginal massage before that. The way that works is that they essentially cut off blood flow to those tense muscles through massage, hoping that the fresh oxygenated blood flowing in helps the muscles to heal and relax. Once again this may feel worse before it feels better due to the lactic acid buildup.
Do not give up on Pelvic Floor Therapy until you’ve given it 6-12 weeks.
If those muscles are stubborn there are options for pelvic floor Botox injections as well as bladder injections. These can also be done under anasthesia during other procedures like cystoscopy and hydro hydrodistention. I honestly recommend doing that because it is very painful without it and may stress the fuck out of your muscles if you’re awake.
hydrodistention is when they fill your bladder to max capacity. This is done routinely to stretch your bladder and to measure bladder capacity.
There is also the bacterial side of things. Some people with IC have overgrowths of bacteria in their urine. There is a 24 hour urine test you can do to look at how your urine is comprised and how much you’re peeing. There is also a culture where they culture all the bacteria’s in your bladder in one inviroment as they would grow inside you. This is to replicate the environment of your bladder to see if you have any antibiotic resistances, overgrowths, or other things.
Ureaplasma and mycoplasma are another theory that’s kinda controversial and expensive to test for. But some consider it an std. it’s a type of bacteria that can overgrow in your bladder, but also it’s kinda a part of the natural microbiome so I don’t know how much credit I give that.
You may notice that you have other conditions such as PCOS, endometriosis, adenomyosis, and or IBS. These conditions are also inflaming your pelvis and can make your bladder more angry if not under check. However, I DONT suggest going crazy trying to cure other pelvic conditions in order to fix your bladder. That’s what I did and it didn’t work as I’d have hoped. I’d try to find multiple doctors or people recommended by ur urogynocologist to help you manage everything together if that sounds like you.
Hope this helps!

Hi. I’m 28f. My medications, vitamins, and supplements are: Iron and vitamin C, Claritin, docusate sodium (which may change soon once I ask my doctor about that), albuterol neb solution. I have a whole host of diagnoses. The relevant ones that I can think of: Iron Deficiency Anemia, low blood pressure, obesity, GERD, a hiatal hernia, past damage to the lining of the stomach, internal and external hemorrhoids (the external ones often bleed), suspected heavy menstrual bleeding with many tiny blood clots in it (I haven’t actually gone to a doctor about that yet, that’s just what I think I’m seeing) and an unknown intestinal issue causing constant constipation or diarrhea (doc has confirmed something is going on re: the stool inside me, we just don’t know what it is yet).
I am also a vegetarian. Have been vegetarian for 14 years, if that matters.
What I want to know is: When should I be going to urgent care or the ER or my primary care for anemia symptoms? Especially on Fridays or Saturdays when it’ll be a few days until my primary care opens again on Monday. My symptoms have been heavier lately and I take longer lately, on average, to recover from any blood loss (even just the tiniest opening in the skin from having dry skin can sometimes have me fatigued and out of breath that day).

If you're interested in baby registry boxes but don't know which one to try or how to even sign up for them I have some info for you here! I got boxes/bags from Target, Walmart, Amazon, Hey Milestone, Babylist, and Similac and I'm still waiting for a box from Enfamil. I'm not an influencer or someone paid by these companies I just really like surprise boxes of stuff. I have pictures but I don't know how to add them. Anyway onto the lists.
Target:
How to get: This appears to have changed recently. According to target.com you join the Target Circle rewards, create a baby registry, add 10 items, and spend $10 from registry (either yourself of someone else). You have to pick up the bag in store with a barcode they give to you and it can be somewhat difficult to get since supplies are limited. When I did this in March all I had to do was create a registry and then go to the store to pick up the bag.
Items:
1 Philips Avent Natural Bottle
1 Dr Browns Anti-Colic Bottle
3 pack sample of Huggies Special Delivery Diapers
2 pack sample of Millie Moon Diapers
16 count sample of Huggies Natural Care wipes
10 count sample of Honest plant based wipes
10 count sample of Water Wipes
2 count sample of Lansinho breastmilk storage bags
2 count sample of Lansinho disposable nursing pads
1 count sample if Boogie Wipes
1 sample of Dreft scent booster for laundry
1 sample of Palmers stretch mark lotion
1 sample of Dapple bottle and dish soap
1 sample of Pedialyte
1 sample of Auqaphor baby ointment
1 sample bottle of Aveno baby wash and shampoo
1 sample tube of Triple Paste diaper rash cream
All coupons are through Target Circle rewards
Walmart:
How to Get: Sign up for a registry at Walmart. Click this link https://walmart.cesampling.com/babybox/soldout and fill out the form and it would be shipped to you for free. Unfortunately these boxes have been sold out since last year but maybe they will restock. I only got one because my OB’s office gave it to me at my first appointment. You’re not missing much by not getting one.
Items:
1 Dr Browns Anti-Colic Bottle
3 pack sample of Huggies Special Delivery Diapers
16 count sample pack of Huggies Natural Care Wipes
1 sample of Arm & Hammer baby laundry detergent
1 sample bottle of Johnson’s head to toe wash and shampoo
1 sample bottle of Aveno baby wash and shampoo
1 pack of milestone month cards
Insert cards (not coupons) for Gerber, WaterWipes, Liquid IV, Aquaphor, and Arm & Hammer
Amazon:
How to Get: Have an Amazon prime account. Create a baby registry. Add 10 items to your baby registry. Purchase $10 worth of items from registry (either yourself or someone else). Wait for the items to ship and then add the baby welcome box to your shopping cart. There should be a $35 coupon applied when you go to checkout.
1 Newborn Swaddle size 36in x 36in
1 Amazon Essentials 3-6 month onesie
1 Mam Anti-Colic Bottle and Pacifier set
1 Bessie's Best lactation cookie
2 count sample of Lansinho breastmilk storage bags
2 count sample of Lansinho disposable nursing pads
1 sample of Aquaphor baby ointment
1 sample of Palmers skin therapy oil
1 sample of Palmers stretch mark lotion
50% off coupon for Shutterfly
10% off coupon for Amazon Essentials (items must be from a list compiled by Amazon)
$20 off coupon for Tylenol Smart check digital ear scope
$200 off Factor meal delivery service
Inserts (not coupons) for Palmers, Aquaphor, Baby Breeza, Mam bottles/pacifers
A card booklet with ideas for the registry
Hey Milestone:
How to Get: Hey Milestone is not a registry. They make three different baby boxes you can choose from and you just pay shipping. If you’re considering multiple boxes it’s best to get them all at once because the shipping will be cheaper. Shipping for one was $12.99. I only got one, the pregnancy box, so I can't tell you what you may expect from the other two. Check them out here: https://www.heymilestone.com/
Items:
1 full size Boudreaux’s Butt Paste butt barrier
1 Herobility 5 oz bottle
1 sample pack of Bamba peanut butter puffs
1 Kudos diaper with 10% off coupon
1 Dr Browns pacifier
1 Nanobebe hospital go-bag kit (includes pacifier, 2 breastmilk bags, 2 nursing pads, 20% off coupon)
2 count sample of Lansinho breastmilk storage bags
2 count sample of Lansinho disposable nursing pads
1 Preggie Pop
1 Bessie’s Best lactation cookie
10 count sample pack of Zahler prenatal vitamins
1 sample of Bella B nipple butter
1 sample of Bella B cradle cap be gone shampoo
1 sample tube of Eucerin baby sunscreen
1 count sample of Jack n Jill baby gum and tooth wipes
1 nail file with info for Mother’s Milk Bank
10% off coupon for Boudreaux’s Butt Paste butt barrier from Amazon
$130 off good chop meat delivery
16 free meals from Hello Fresh
$1 off Bamba snacks
1 insert for Forsite 350 genetic testing
Babylist:
How to Get: This one is by far the most involved process. Create a registry on Babylist. Enter in your baby’s due date, you address, and first and last name. Add three items from the Babylist shop. Add three items from other stores (you can do this by putting a plug-in from the website on Chrome or Firefox. More detailed instructions on the website). Complete 40% of your registry checklist (you can do this by just checking items off yourself). Spend $30 from your registry at the babylist store (either yourself of someone else). The $30 must be spent on items from the babylist store! Once these things are done you can pay $8.95 for shipping or you can chose simple shipping and it’s free.
Items:
1 Herobility 5oz bottle
1 Philips Avent Natural bottle
1 Monica and Andy baby hat
1 Small Story 0-3 month onesie and 20% off coupon
1 Parker bib with 15% off coupon and a chance to win $200 giveaway
1 Nanobebe first pacifier
2 pack sample of Kudos diapers with 10% off coupon
2 pack sample of Healthy Baby diapers
2 pack sample of Parasol diapers
10 count sample of Honest plant based wipes
10 count sample of Water Wipes
10 count pack of motif medical breastmilk bags and 15% off coupon
1 sample tube of Noodle & Boo body wash and shampoo
1 sample tube of Noodle and Boo lotion
1 Bessie’s Best lactation cookie
2 count sample of Lansinho breastmilk storage bags
2 count sample of Lansinho disposable nursing pads
1 sample of Wellements probiotic and $15 off coupon
1 sample tube of Aquaphor baby ointment
1 sample of Desitin
1 sample of Palmers skin therapy oil
1 sample of Palmers stretch mark lotion
1 sample of Bird&Be vitamins and 15% off coupon
1 sample bottle of Vivi & Bloom body wash and shampoo
2 samples of Triple Paste diaper rash ointment and $2 off coupon
Coupon for a free onesie from Oso and Me ($32 value)
Coupon for free 8x8 photo book from Shutterfly
Coupon for a free will from Trust & Will
Coupon for free Swaddle from Little Unicorn
1 insert for babylist health for information on free breast pumps
Similac:
How to Get: Sign up to my Similac rewards at https://www.similac.com/rewards.html . It’s completely free. I do recommend using an email you rarely use though and don't put in your phone number.
Items:
1 7 oz can of Similac 360 Total Care formula
1 7 oz can of Similac 360 Total Care Sensitive formula
1 sample of Pedialyte
1 free 8x8 photo book from Shutterfly
Coupon for 1 free session at JC Penny portraits and 1 free 8 x 10 print
Coupons for $50 off Similac formula (They will send more in the mail once you use these)
16 free meals from Hello Fresh
Coupon for 50% off Shutterly
Coupon for $20 off Lovevery play kits
Coupon for $3 off Pedialyte
A collection of 12 gift cards to places I’ve never heard of ranging from $60-$30
Enfamil:
How to get:
Sign up for Enfamil Beginnings at https://www.enfamil.com/baby-formula-coupons-samples/ . It’s completely free. I do recommend using an email you rarely use and don’t put in your phone number. I’m still waiting on my Wonder Box to come. They tend to ship close to your due date so I may get it soon.
Overall thoughts: I enjoyed the fun of going through the boxes to see what I got. The Walmart one is no great loss to anyone not able to get one. I was disappointed with the Amazon one because I expected it to be a bit better based on what others had gotten. Plus I didn’t get the Dude Wipes people were getting and I was looking forward to them lol. The Babylist box was the best of the bunch, which is good considering the hoops you have to jump through to get it. Hey Milestone was great for the butt paste and bottle alone. I was also really pleased with the Target bag. These are just the things I got and each box/bag may be different.

I've been using the YTTP caffeine + vitamin c serum in my morning routine for the last few months. I had bought the product a long time ago but just reintroduced it daily as I picked back up on a full morning skincare routine. I've loved it... so much glow, great base for sunscreen and makeup. I'm almost out of the bottle, so I went to the Sephora site to restock but noticed a ton of reviews mentioning a potential reformulation causing skin rashes, swollen/red patches, etc, so got a little freaked out.
I decided to search around for a different vitamin c serum to use in my morning routine, but I'm seeing the exact same thing everywhere... almost every single vit c serum product has a fair share of reviews mentioning a reformulation and skin reaction. Not just sephora, but reviews on individual brand websites too.
What in the world is going on here? Has this always been the case, that some folks are just sensitive to vitamin c and would have this reaction no matter what, or is this an issue with the source of the vitamin c itself?
I'm torn on if I should even buy any product right now, or if I just take a gamble on the YTTP one since I've used it in the past and I personally have never had a problem with it? So strange...

Since I still get random messages from my old posts, here is the latest skin barrier repair advice I have.
Look into a brand called Stratia. They have a product called lipid gold. It’s a barrier repair cream and has all the building blocks for the skin barrier. This is what you’ll want to focus on using mainly. The next thing you’ll want to focus on is using a proper sunscreen during the day. I recommend the beauty of joseon relief sun sunscreen. You’ll want to start applying every two hours during the day when the uv index (look into uv index if you don’t know what that is) starts to rise from zero. Apply every two hours and apply enough, not just a little.
You also want to focus on hydration since that helps with repairing skin. Some people live in a very dry climate like myself, so I use a humidifier to keep my skin from feeling so dehydrated at night. Also try to focus on finding hydrating skincare.
Here are other products I recommend: Stratia rewind (a niacinamide based serum that boosts barrier repair) Stratia fortify (has a blend of oils to repair skin and omega 3,6,9) Maelove The Hydrator (a very hydrating B5 serum with hyaluronic acid, very concentrated) La Roche Posay Cicaplast (a strong occlusive moisturizer to lock in all your skincare to use at night only, also has barrier repair ingredients) Stratia Velvet cleansing milk (pricey but can’t be beat for how gentle and effective it is at cleansing. You absolutely need a cleanser like this for irritated broken barriers)
Broken skin barriers tend to be dehydrated, so a technique I discovered for hydrating my skin while I apply all my products is using a water spray mister between steps. So what I do is mist my face, apply my skincare product, then start a 2 minute timer until it feels like the product has absorbed. I used to just throw on skincare but it didnt feel like it was working right until I let them absorb properly with enough water on my face. So ill spray before each product, and especially before my final occlusive moisturizer to really lock in all the moisture.
You should try to eat a healthy diet. Skin health is covered by a variety of vitamins and minerals, not just one thing. If you struggle with eating right, I suggest a multivitamin called Thorne Basic Nutrients 2/Day. You can also looked into a brand called Nootropics Depot and a supplement from them called Injuv. Injuv has the ability to improve barrier function by helping raise your hyaluronic acid levels inside your body. It’s interesting stuff.
If you want to go a step further to heal the irritation, you can just focus on washing and applying stratia lipid gold plus the la roche posay cicaplast at night, and lipid gold plus the sunscreen during the day. Doing that for 2 weeks straight will help reset the skin to handle more products.
Sorry if it sounds like I’m explaining a few things people on this sub might consider obvious advice, but I’m trying to explain it as if whoever reads this isn’t experienced at skincare.

I’ve spent the last four months caregiving for my mom. It started back in September with optic neuritis, but then she developed sepsis from a blood infection. At the time, no one knew that the infection had damaged her bones. Two months later she needed emergency surgery to repair her back or else she would be paralyzed. This was an incredibly risky procedure so talks about her wishes had to happen. I live with my mom too so all of her care and her medical needs fall on me. I even work a full time job with a business on the side so this adds to my stress.
She’s now recovering at my sister’s and going to PT. But she plans to return home in two weeks since she’s making very good progress. This is gonna sound terrible, but I’m dreading it. I love my mom but I have nothing left to give her and I know she will need me again.
During this time my physical health has taken a hit. I’m sick again with a sinus infection for the 6th time in the past four months, my seasonal allergies are now severe, my sleep quality is terrible, I’m breaking out, I developed a skin infection and now I’m on antibiotics, my hair is suddenly very thin and I’m seeing scalp, I’m much more pale looking, I lost weight despite eating more, it feels like I can never get a good breath in, and it’s like all of my energy has been zapped.
I don’t feel emotionally depressed at all but it’s definitely like a physical depression. It’s hard to shower, wash my hair, cook, get up for work, relax, or brush my teeth. EVERYTHING feels hard to do now even what I enjoy doing.
My therapist said it sounds like adrenal fatigue, but that’s a highly debated topic. My psychiatrist is also at a loss since my ADHD meds are less effective, and my primary said my blood work results from a few months ago were okay. Only my iron was on the low end, but even then I’ve been supplementing and eating iron rich foods. I also take calcium, vitamin D, magnesium, probiotics, and vitamin C.
I just wanna feel okay again and I’m tired of being tired. I’m terrified that I will really hit rock bottom once my mom returns.

Introduction:
In the ever-growing landscape of pet care products, one segment that has gained significant attention is dehydrated dog food. As pet owners become increasingly conscious of what they feed their furry companions, the demand for high-quality, nutritious options has surged. In this blog post, we'll delve into the world of dehydrated dog food, exploring its ingredients and shedding light on what makes it a preferred choice for many pet parents.
Understanding the Dehydrated Dog Food Market:
The dehydrated dog food market has witnessed remarkable growth in recent years, driven by factors such as increasing awareness about pet nutrition, rising disposable incomes, and a shift towards natural and minimally processed foods. Unlike traditional kibble or canned dog food, dehydrated options offer a unique proposition by preserving nutrients through a gentle dehydration process.
Ingredients Matter:
Quality dehydrated dog food stands out for its premium ingredients, carefully selected to provide optimal nutrition for canine companions. Let's take a closer look at some key ingredients commonly found in top-tier dehydrated dog food products:

1. High-Quality Proteins: Proteins serve as the building blocks for a dog's muscles, organs, and immune system. Look for dehydrated dog foods that feature real, high-quality sources of protein such as chicken, turkey, beef, or fish. These proteins should be free from fillers, by-products, and artificial additives.
2. Nutrient-Rich Fruits and Vegetables: Just like humans, dogs benefit from a diverse array of fruits and vegetables in their diet. Dehydrated dog foods often include ingredients like sweet potatoes, peas, carrots, blueberries, and spinach, which provide essential vitamins, minerals, and antioxidants.
3. Healthy Fats: Dogs require a balanced intake of fats for energy, skin and coat health, and overall well-being. Look for dehydrated dog foods that incorporate sources of healthy fats such as salmon oil, flaxseed, or coconut oil. These fats should be rich in omega-3 and omega-6 fatty acids, which support skin and coat health, joint function, and cognitive function.
4. Natural Preservatives: To maintain freshness without the need for artificial preservatives, quality dehydrated dog food market often utilize natural preservatives such as mixed tocopherols (a source of vitamin E) or rosemary extract. These ingredients help extend shelf life while ensuring the product remains wholesome and nutritious.
5. Probiotics and Prebiotics: Gut health plays a crucial role in a dog's overall health and immunity. Some premium dehydrated dog foods may contain probiotics and prebiotics, which promote a healthy balance of gut bacteria and aid in digestion and nutrient absorption.

Benefits of Dehydrated Dog Food:
Choosing dehydrated dog food offers several benefits for both pets and their owners:

• Nutrient Retention: The dehydration process gently removes moisture while preserving the nutritional integrity of the ingredients, ensuring that dogs receive essential vitamins, minerals, and enzymes.
• Convenience: Dehydrated dog food typically comes in lightweight, compact packages that are easy to store and transport, making it convenient for pet owners, especially those with busy lifestyles or limited storage space.
• Customization: Many dehydrated dog food brands offer customization options, allowing pet owners to tailor the food to their dog's specific dietary needs, preferences, and health concerns.
• Reduced Allergen Risk: By avoiding common allergens and fillers found in traditional dog foods, quality dehydrated options may be suitable for dogs with food sensitivities or allergies.

Conclusion:
As the demand for premium pet nutrition continues to rise, understanding the ingredients that go into quality dehydrated dog food market is paramount for pet owners seeking the best for their canine companions. By prioritizing real, nutrient-rich ingredients and avoiding fillers and artificial additives, pet parents can provide their dogs with a diet that promotes health, vitality, and longevity.
In a market flooded with options, discerning pet owners can make informed choices that prioritize their dog's well-being, ensuring that every meal is a nourishing and enjoyable experience.

I want to do this at home because its too damn expensive in Salons. Usually I don't really do that at (like at all), but my skin care routine consists of facial cleanser first, then vitamin C serum, Moisturiser, and sun screen. This is in the morning. While at night before i sleep i just use facial cleanser and a Moisturiser.
Noting that i have a very oily skin, not sure what type of syrum i can also use, especially at night in addition to what i do already.
Main thing is as the title states, i want to do deep cleansing once every week or 2. But not sure of the steps after steaming. I looked up some youtube video, not sure if for my case with very oily skin this makes sense? The steps in the video basically are: 1) steam face for 5 minutes 2) extract pores using two q tips 3) exfoliate with brown sugar and extra virgin olive oil 4) use toner 5) use honey, sugar and lemon for lip scrub (probably wont do this one) 6) moisturize 7) use maracuja oil.
For steps 3 and 4 and 5, i will just buy those instead of using home stuff, but for step 7, what is maracujq oil good for anyway? If it doesnt really suit oily skin, what can i substitute it with? A serum maybe that has hyaluronic acid ? (I read serums with this are gd for oily skin).
One for question, after steaming and when i want to extract pores and such, is it also a gd idea to use the spatula kinda scrubbing machines? Or its not needed if after extraction im using an exfoliating scrub?
Would be grateful for your input 🙏

There is no guarantee that what we do or say will bring an understanding smile or a happy outcome. But there are ways to make it easier for the other person to accept the reality of the situation. Basically, the core idea is: don't cheat, don't hide, and try to manage the other person's misunderstandings and prejudices. I just have herpes, so what, I'm still in control.
1. Don't say how you contracted genital herpes, say what genital herpes is.

• Tell the person some scientific medical facts. For example, what is HSV, what is the herpes virus, and how is it transmitted. These words are really alarming when they come out, but the information behind these words is very useful.
• It's a lot smarter to get the facts out and tell the person what the genital herpes virus is than to come up to them and say, "I accidentally got infected by someone I was having sex with. "This kind of factual opening will focus the person's attention on the fact that genital herpes is really just a skin problem.

2. Don't assume that just because other people have heard of genital herpes they really know (understand) genital herpes.
For some basic questions like the prevalence of the herpes virus, are oral herpes and genital herpes are contagious to each other, etc., choose 4-5 key facts and keep them in mind, it will keep you and the other person grounded.
3. Don't just tell the person that you have genital herpes, but also tell them how you are treating your herpes virus.
If you've done the first two, you're already halfway there, the next thing you need to do is to tell the person how you're being proactive and tell them that these are efforts you're making to prevent recurrences. For example, exercising, boosting the immune system, taking vitamins, or taking suppressive therapies, and more importantly, letting them know that by taking these positive actions, we are also doing our part to protect others.
4. Don't sing a monologue, create a dialog.
Since genital herpes is a very common virus, your partner has likely heard that the chances of people around hehim having the infection are still high. If this is the case, then it is a good entry point to start a conversation with the person about genital herpes to know how much she/he knows about the virus, what hehis views are, etc.

• After you inform him/her that you have the genital herpes virus, try asking some questions: do you know anyone else who is infected/carrying this virus? Or have you heard of anyone infected with this virus? Have you ever socialized with someone with the herpes virus before? And so on.
• Make sure you can have big and accurate enough information to give the person a sense of security when being honest with them. For example, they can ask me any question about herpes that I can answer. Generally, conversations with this kind of content seem to be awkward, but it's actually a turning point because regardless of whether or not you and your partner are going to have further intimacy after this, notice that you're genuinely, honestly, communicating about this stuff that you wouldn't normally discuss on a date.

5. Don't feel ashamed! Be confident!
At the same time, we need to know. As long as there is an intimate relationship there is a chance of being infected. Whether it's with a boyfriend, with a girlfriend, with a stranger, for the first time, for the 100th time, with protection, or without protection, all of these situations, the risk of contracting genital herpes exists.
We are not being alarmist or bringing despair, this is the truth. We need to stick to that and hope that the person we are with can do the same.

• There is a "seven percent rule" when it comes to communicating with people, which means that only 7% of a conversation is actually verbal, while the remaining 93% is non-verbal, such as body language, facial expressions, tone of voice, volume of voice, body posture, and so on.
• What you say is important, how you say it is even more important. Look the other person in the eye and make eye contact. Your attitude is important. As you express your own feelings, it's also how you see yourself. Remember you are not begging the other person to accept your herpes.

Finally, to summarize, you could start like this:
"We've been on two dates now, and there's something I'd like to talk to you about; I have a skin problem that breaks out once in a while when my immune system is low."
"This skin problem is genital herpes, which you may have heard of, but I'm guessing you don't know much about it."
"I have tried suppressive therapy to prevent recurrences, specifically, I would take anti-viral medication every day to keep this virus at bay."
"It's a very common virus, one in six Americans carries it, and over 400 million people worldwide carry it, so maybe you know someone who has it?"
...
That's pretty much the structure, feel free to give each other all the science you know, and remember, don't be a crybaby, the sky isn't falling.
Good luck!