Normal xray with severe shoulder pain

Am i autistic?
Lately I have been going through more issues with my health.
Fyi, i have Marfans, MVP, Fibromyalgia, Panic Disorder, Heart Palpitations, Frozen Shoulder, lower Back isues, crowded teeth, flat feet, joint pain, low energy.
Recently my mental abilities are getting worse. Sensitive, low pain tolerance, memory loss, slow information processing, brain fog, poor concentration, poor hand eye coordination, lack of eye contact, obsessive compulsive, lost in thoughts, cannot socialize. My wife has given up on me. I keep asking the same questions and i still can't follow. I am a teacher by profession. I lost my mother 2 years ago.
Please help.

i’m sick. suddenly got hit with runny nose and kept sneezing. also have sore throat. been sick since last saturday (it’s wednesday 12am) my period was expected yesterday but it never came. i’m assuming the sudden cold threw off my cycle. i just want my period to be over with as my period cramps can be extremely painful + i have tests and exams coming next week. so i wouldn’t want it to affect my grades (it happened twice before) how do i make it come faster so i can get it over with ? what are signs i should be looking out for so i know it’d come ? lately my stomach have been very bloated or just felt very tight and uncomfortable at night. it’s normal for me but it’s still super uncomfortable.

Hi everyone. I am not scheduled for surgery yet, so I have some time to prepare. Obviously, I will ask this question at the appointment, but I'm curious how much time is normal to need off of work post-surgery.
I realize that a lot of variables play into this and that anyone can end up with post-op complications that can extend the recovery period!
Assuming a normal surgery and recovery, how long until you felt both physically and mentally ready (and were cleared) to go back to work? I work a desk/office job that is 100% remote/work from home with no physical labor. I can literally work from bed if I want to, which is what I do on my high period pain days. I'm mostly wondering because I just started this job two months ago, so I don't have a lot of PTO saved up yet, and I can't take FMLA until I've been there a year. Of course, I wouldn't try to just work immediately. I'm simply trying to figure out how much PTO I should plan on saving up.
I do get a wonderful amount of PTO and personal days at my job (25 days PTO, 2 personal days, and 4 floating holidays), but I will need to accrued them first. The company won't let you go into negative PTO. It seems like two weeks off is a good basic starting point, from what I've read on here, but I'd love to hear personal thoughts!
For context, I've had a few major surgeries in my life, including a14-hourr surgery that removed 5 organs from my abdomen, so I'm no stranger to surgery and major body recovery! I know to get up and walk as soon as possible, I know about the gas pains, how to listen to my body, etc.

The patient presented with what appeared to be normal H but insisted she had a severe HL... OK, fine. Got her into the booth, hooked her up, and presented at 40 DB. Red... dropped to 30 Red, dropped to 20 Red, dropped to 5 red... at that point, decided just to do the main 4 and turn it into a screening. Got the patient out and said, "You're great! No issues, congrats!" She then said, "Oh no, no, I thought you said to push when I didn't hear anything??"
I said, "What? No, you did it correctly. You pushed it at every tone. You're fine. "
She then continues, "No! I didn't hear anything, I swear. Can you retest me?"
At this point, I'm just thinking ... OK crazy..
Get her back in, present at 40. Nothing. Move to 50 nothing, 60, 70 (at this point she's contortions her face, 80 red.) Responding validate and she's all over the place. Yes, no, yes, no
Classic malingering. At 3K, I stop the test and tell her she's done. She's getting out of the booth, and I begin to counsel her on what appears to be going on. I ask, "What's the deal here? You clearly would not benefit from any treatment, so tell me why you insist on needing a hearing loss?"
Finally, after round 6 of the discussion- she admits (long story short) that her grandmother raised her, she's going to college in a few months, and grandma can not hear. She's worried about this, and because she is on state insurance but grandma only has Medicare. She was hoping to give her these. I counseled her on individual loss, why her RX would not fit Grandma's, and law and ethics.
She was devastated. I invited her back WITH Grandma, and I plan on gifting her the new top of line series. But never have I seen something like this. If anything, it's the opposite. Spoilt adult children whining that their small should be there inheritance is being wasted on preserving cognitive abilities in Mom or Dad.

So i recently found out about this feature but its a pain in the ass to find the right save adresses for certain things so i decided to share some i found for zelda 2 to help others. IMPORTANT: you have to set the search size to 8-bit because the NES is an 8bit console. INSTANT ESCAPE from fight: 200(000000C8) set it to 3(00000003) to escape enemy fights or traps instantly. Be aware that you have to disable this cheat to be able to get into dungeons, caves or villages. The LIFE value is stored in cell 1908 (00000774) set it to a steady value to be invincible. if you want to be able to shoot with your sword set it exactly to the max value for your amount of heart containers for me this value is currently 191. you may have to try this out a little bit. MAGIC value: 1907 (00000773) same as health. STRENGTH/DAMAGE value: 1911(00000777) set it to max (255 for 8bit) to oneshot everything some visuals are a little bit off because you cant get the value this high normally but wont make the experience worse. RESPAWN value: 1792 (00000700) in case you fall into the lava or something. again set it to a steady value to be able to respawn as often as you need to. If you have some more codes feel free to leave them in the comments.

Hi Everyone Wanted to share my experience dealing with joystick drift on my xbox controller.
So my original controller which came with the Series S started showing signs of joystick drift around 1 year after the purchase. Initially I bared it, but it became a pain when playing games such as overcooked 2.
Spending 5k more on buying a controller didn't seem to make a lot of sense since I had one more controller, the only issue was with couch co-op games.
So I first tried to call up local repair shops and they quoted me insanely high numbers to replace the joystick - roughly 2k. I live in Hyd, these prices might be lower in places such as Delhi.
Then the engineer in me got an itch, and I thought why not replace it myself. Searching on amazon I found this - TCOS TECH Xbox Series X/S Analog 3D Analog Joystick Replacement for Xbox Series S Xbox Series X Wireless Controller : Amazon.in: Video Games (not sponsored or affiliated in any way)
I thought it should just be a simple soldering job and I ordered a soldering kit with this.
Then I started, and oh my, it was a really scary experience.
So the difference between soldering normally, and removing solders made by hand is generally very easy. But in things such as the controller, the soldering is done using automated machines on the PCB.
Removing these solders is not possible using normal soldering guns you might have for hobbies etc. They require significantly more heat to remove.
So yeah, I spent a long time trying to heat and remove the solder to no avail, the PCB almost changed a bit of it's colour, and I was like I have anyways messed this up.
Then I started exploring more on youtube to see more simpler techniques, there were techniques around just breaking the potentiometers/joystick instead of the solder, and then just move it back and forth to break the solder.
I thought I'll do this on the whole joystick, but just doing it on one of the potentiometers was too much effort and scary. Scary in terms of breaking the whole thing up.
Then I ended up only breaking 1 potentiometer (the front-back one which had the drift) and then replacing it with a potentiometer from the one I had purchased. After much more effort and abusing the PVC very badly with heat, solder and the hole from where I removed the older potentiometer, it looked like a complete mess. I was worried if it would even turn on.
Luckily after few minor adjustments, the joystick was working perfectly. I can honestly say, I felt super happy!
Fast forward to 2months since this, now the joystick has a different kind of problem, where it randomly gets stuck in top direction, hopefully might be fixable with minor tweaks.
All in all it was a very scary experience (of destroying my whole controller), and I won't recommend it to anyone if you don't have advanced soldering skills and equipment.
Better approach would be to buy a stick like this online and then maybe go to a mobile repair shop and pay them some money to help with soldering.

I spoke with our geneticist already but wanted to hear if anyone has gone through something similar before or if any genetic specialists can help me interpret the situation.
Our microarray results came back normal HOWEVER the geneticist called us to explain that :

• when they initially ran the test with the direct cells taken from the amnio, "There was a 400kb deletion of a clinically significant gene (NBEA), but the log ratio is not as deep as we would typically expect." < in other words, not a clear deletion but system did flag it
  
• they cultured the cells and ran the array test again as well as a FISH on that specific region and both tests were normal. Notes say: "We do see a region of absence of heterozygosity at this locus in both the fetus and mother, which we think may have triggered the software to overcall it as a deletion"
  
• based on this, they reported back a "Normal" result but wanted to let us know of the earlier finding because it's a genetically significant finding associated with a rare but severe neurological condition. Also, technically there could be a difference between the cells in the direct sample vs the cultured one.
  

The only option they gave us to get more assurance on this is to do another amnio so they can run a FISH on that specific area.
My thinking/questions: - it sounds like the genetics team has already done a lot of due diligence to confidently say its a false positive, so the chance this is a true positive is very low (probably lower than risk of another amnio?) - on the chance of direct cells giving a different result than the cultured cells, don't a lot of microarrays get done based on cultured cells anyway? - should we even be worrying about this based on everything we know already? For context - 4.6mm NT, normal expanded NIPT, normal 16 and 20wk anatomy scans and fetal echos, normal FISH results on the 3 trisomys and sex chromosome
Any thoughts/opinions would be appreciated!

Hi I have severe gerd for 10 years, 5 years on PPi, I have reflux, bloating, burping, bloating etc etc. Gastroscopy showed Hiatal Hernia, esophagitis, les not closing and inflammation and all of this on ppis already(what would be be without them not sure). The first gastro "cured" me with diet but shortly after all of my symptoms started again. I could never be without ppis longer that 10 days. Diet is not helping much, I can have gerd even after porridge on water. Today wad the day when I decided I will tell her nothing helps and I want to visit the surgeon. But I already spoke to the surgeon and he suggested barium radiography. She admitted I am young and I spend lots of money on medication and it is hard to live like that in my ages(33 female, no kis, endometriosis and chronic pain). So she said she will give me that referral if this test shows I need surgery. I will first go to he surgeon after the test and if he says he can perform surgery, the gastro will give me the referral for surgery. I am very happy today I was not dismissed. I have to pay out of pocket for this test but it is fine. I am used to buy all the meds for years now, which are very expensive. I would like to know your experiences with Fundoplication. How was it? I have some fears about it. I am very used to vomit because of gerd and when I cough, when I got food poisoning. How will I be after surgery if I need to vomit? And also, how was that one month in which we have to eat liquid diet? Also i have a history of eating disorder and I am so afraid of it. But I would do anything at the end to get rid of gerd and to be able to eat a tomato without having to take ppi for one week after and before.

For this setup, I am using Ruan Mei at E0S0, Gallagher at E6S0, Harmony MC at E5S0, Bronya at E1S1 as the supports.
Jingliu and Firefly are both E0S1.
Firefly is going to have 10 rolls of BE, 4 rolls on spd and 7 rolls of attack on substats and the rest are wherever Jingliu is going to have a total of 25 rolls on crit stats and 5 rolls on atk.
Why Gallagher? For fairness of this comparison, Im using Argenti as the boss to fight against. Damage that will be computed is only for the 0th Cycle.
Firefly is using RM, HMC and Gallagher. Enough said.
Jingliu Team is Bronya, RM and Gallagher. Gallagher to help break Argenti faster since Jingliu would then suffer from the Broken Multiplier from being 90%. RM also here is a bit better than Pela so I did not bother changing her for Pela. (Plus we will be back to the Weakness break argument again about the Broken Multiplier)
Crit Rate and Crit Damage in here are from Base Character page while BE is after RM + MC + Watchmaker are up
This is a fight wherein I am only taking into account the damage vs Argenti himself and not including the shields.
The boss Argenti has a toughnes of 480 and on a MoC setup even. With these in mind, below are the result of the damage per cycle:
I included the Boss remaining toughness so that everyone has an idea on how much toughness gauge is left. X on the table is a marking wherein damage would be considered irrelevant. I was tempted to put X on Jingliu's normal skill but alas, presented it for everyone to see that irrelevant damage is even lower than that.
The big spike in damage for both Firefly and Jingliu when enemy toughness becomes 0 is due to Ruan Mei. And for Firefly, both Ice Break from RM and her own Fire Break Damage procd.
The comp for Jingliu is her best performing comp vs Argenti that has a sustain.
Right side is the Ice Break Damage of Ruan Mei for the Jingliu comp.
What people fail to realize is that, on the Firefly comp, everyone is capable of doing Super Break damage. And for the AoE scenario, Firefly has an advantage over any other unit as she breaks multiple enemies fast thanks to her Blast hit and huge toughness reducing damage.
For a more clear view of how much toughness reducing damage each does before weakness break efficiency takes in effect. Also is the reason why she used Gallagher. Coz Jingliu's weakness breaking capability is quite weak.
From the tables above, the Firefly comp is already doing almost 2x the damage of a Jingliu comp. This level of damage is higher than Imbibitor Lunae and is on par with Acheron. This is why, if Firefly either gets the ability to crit consistently while keeping her stats above or is able to proc Super Break by herself then her team is going to leave behind every single DPS comp in the game.
And keep in mind, Jingliu had almost max investment on her offensive stats while Firefly has so-so investment that there is a difference of 9 rolls that Firefly can still give to her BE substats for even higher damage.
I made this post as I have seen several people saying that if Firefly gets buffed, shes going to be atleast DHIL/Jingliu level. I take that as an offense, since as an E6S5 Jingliu owner, I have never seen my Jingliu hit for the amount of damage the Firefly comp does overall that is. Of course i compared my E6S5 Jingliu with an E2S1 Firefly with E1S1 RM and such so I presented an E0S1 variation of both of em.
The gap would be wider as well if RM is E1 as multiple characters on the team are doing Super Break Damage.
Yes, her team comp might be super restrictive, but 2 technically free characters, Firefly and a Harmony character that every content creator recommended others to pull for 5 months ago. I would say, for the amount of damage the team is doing, theyre quite F2P friendly.

Hi friends, We recently started writing about Danish idioms on our newsletter the Simple Danish Newsletter - I also started posting them here on Reddit, but I have not been great at keeping up, and so now I am 12 weeks behind here on Reddit, and rather than space out 12 different posts, I thought I would do one big post and hopefully get back on track with the postings 😅 So here’s a bunch of Danish idioms for you!
At have det som blommen i et æg
Litterally; to feel like the yolk in an egg. I like this idiom a lot because of how visual it is. It means that you feel good, you feel comfortable, protected, and in the right place.
For example:
A: Se de søde killinger der sover.
B: Åårh, de har sikkert som blommen i et æg.
En heldig kartoffel
Literally, a lucky potato. If someone is especially lucky, in Danish ,you can call them a lucky potato. As far as I can read, the expression comes from an old sailors game, where you would pass a potato around in a circle, and a person in the middle would try to catch it. If the person in the middle could not catch the potato, it was said to be a lucky potato.
For example: A: Jeg har fri på fredag, så jeg kan nyde det gode vejr.
B: Din heldige kartoffel.
A: Har du hørt at Jonas har vundet i lotto? B: Sikke en heldig kartoffel!
En varm kartoffel
Something can also be a hot potato. It is the same expression as in english, where an issue can be a hot potato. Something so hot that it is painful to touch, and so something you would want to avoid. This expression is less used in Denmark, and mostly by newspapers or the older generations.
Lokummet brænder
Litterally: The toilet is on fire.
Either you are in big trouble or you are about to be in big trouble when your toilet is on fire.
Lokum in Danish used to refer to the old shed behind the house, where hole-in-the-ground-with-seat type toilets with no running water were found. Nowadays the word can also refer, with some disgust, to normal toilets.
For example:

• Danskerne er gode til at få psykologisk hjælp når lokummet brænder.
  
• Når lokummet brænder, ved jeg at jeg altid kan regne med dig.
  

Så er den ged barberet
Litterally translating to; then the goat is shaved. Means that something is done or solved. You can use it if you got an annoying task out of the way, either by avoiding the task entirely (and then ironically using så er den ged barberet to humorously say that it was easy), or by actually finishing it.
Example 1: Jeg skal lige færdiggøre den sidste del af præsentationen, og så er den ged barberet.
Example 2: FCK scorede et hurtigt mål mod Brøndby, og så var den ged barberet.
Hvor kragerne vender
Where the crows turn around is used to to mean the same as in the middle of nowhere, although I like the illustrativeness of the Danish phrase much more than in the middle of nowhere. It means somewhere so far away, that even the crows don’t dare go there. You can for example say; Rasmus er vokset op på landet. Der hvor kragerne vender. Or if someone asks you what you did this weekend, you can say: jeg var ude at gå en tur, helt derude hvor kragerne vender. Or if people ask you where you are from: jeg er fra en lille by ude hvor kragerne vender.
Den der kommer først til mølle, får først malet
Litterally; The one who arrives first at the mill will get milled first. This is pretty much the the Danish equivalent of first come, first serve, mixed with a bit of the early bird gets the worm. However in everyday life, you pretty much only hear the first part; først til mølle or you might see something like; “efter først til mølle princip” which was recently added to the Danish dictionary. You might see the phrase if you are looking at items being given away for free or being sold online. I can definitely see how the isolated phrase can confuse new learners though: “Selling sneakers. First to the mill.”
So now you know 😊
at spille kong gulerod
At spille kong gulerod, to play king-carrot. You can use this expression if someone is acting arrogant, cocky, or superior in a pretentious way. You can for example say du skal ikke komme her og spille kong gulerod if someone is being pompous around you. The phrase apparently comes from an old french, satirical opera from 1872, where vegetables from the garden take control over France. Or so I’ve heard. Don’t cite me on that.
At købe katten i sækken
Literally meaning to buy the cat in the sack. To buy the cat in the sack, means you got cheated in a trade, or that you were not diligent enough when checking what you were buying and got something not worth a lot. You can change the person or the idiom in the idiom as in jeg har købt katten i sækken meaning you already made the bad deal, or you can say hun køber katten i sækken in the 3rd person future tense if someone is going to make a bad decision. You can use it as a warning to someone Pas på du ikke køber katten i sækken if you think there’s a risk they will not make a good choice later.
At gå som katten om den varme grød
Litterally; to walk like the cat around the hot porridge. We use this idiom when someone hesitates to speak directly about a sensitive subject, when they skirt around the issue. I imagine a cat, interested in eating a nice bowl of hot porridge, but the cat is hesitant because it is afraid of burning its tongue.
Example: I forbindelse med spørgsmålet om klimaforandringer, gik politikerne som katten om den varme grød.
at skyde papegøjen
To shoot the parrot, or to have shot the parrot, means to be very lucky. It can also mean to have gotten hold of a very valuable object or person. It is in a sensee the opposite of having bought the cat in the sack. Here’s a few examples:
Rasmus har skudt papegøjen med hende Antonina. Hun er godt nok sød. Jeg har skudt papegøjen her I weekenden på loppemarkedet.
Det med småt
“that with small/little” or more legibly: the fine print.
Har du læst det med småt? Did you read the fine print? You will often see this when websites are trying to be transparent or quirky about their terms and conditions. So you might encounter a link or a website titled “det med småt” if you are trying to buy something.
That was all for now 😅 I apologize in advance for formatting problems, as I am writing this on mobile as apparently this is the only way Reddit will allow me to post multiple images.

About two months ago I started having stomach aches/cramping, changes in bowel habits and a feeling like something was stuck or like I wasn’t done even if I’d just gone to the bathroom or knew I didn’t need to go. I went to a GI about two weeks later and she said it could be colitis or IBS, she called for a FIT test and blood work (both came back normal) and a six week diet (two weeks gluten free, two lactose free and two fodmap). While the stomach pains went away, the changes in bowel and the feeling of something stuck or incomplete did not go away. I had a follow up yesterday and now she has ordered a colonoscopy for a month from now. She mentioned it could be internal hemorrhoids or colitis and also said she’s not worried but still wants to go in and look. Even though she seems unconcerned I am terrified. My worst fear is that it could be something much more serious and that diagnosis is taking too long. My question is do those of you who have experienced similar symptoms agree with her assessment or could my fears be valid and I should do more to get answers sooner? All thoughts welcome, thank you in advance.

My mare was tied to pipe gate Friday night attached to an electric fence to be fly sheeted. She does not need to be tied to be fly sheeted and everyone is supposed to be using the cross ties in the barn, not tying horses to gates. She loves her sheet and stands still for it. The electric fence zapped her as she was tied too close to it, she spooked, pulled back, took the gate off the line and her rear legs were stuck through it, and her face tied to it while she galloped around the property panicking. She suffered severe lacerations on all four legs, ripped her chestnuts off, ripped a shoe. has cuts between her butt cheeks, is swollen everywhere, and is traumatized. Stall bound for at least 3 weeks and she is normally a 24/7 pasture girl. I am so sad, and upset for her. She is not happy.
I was called about it and raced to the barn. The vet would not come out and wanted her trailered in for stitches. I opted not to stitch the biggest wound, but wrap it as it is on the front leg and would rip out instantly. We treated her, got antibiotics, bute, muscle relaxers fulfilled. Was in contact with my personal vet through photos, texts, etc.
I was told by the barn manager exactly what happened and the individual at fault. I am being sent bills for her medications and supplies, and I have a feeling they will send me a bill for stall board as I pay pasture board. I am not okay with this as they admitted fault and my mare is not accident prone. I do not even know what physiological issues she may have after her wounds heal. I signed the board agreement when I moved there with the typical rules about equines being dangerous and that they would not be held responsible for injury, etc. But this is not a random pasture accident, this was a stupid decision made by an idiot to tie my horse to a mobile object that has NO safety release or breakaway. The cross ties do.
I have had a terrible last few days. Has anyone dealt with something like this? What do I do? I love the facility and moving her is out o f the question right now. I will not refuse treatment for her either, of course. But I do not think this is right.

“Meet the Grandparents,” Chapter 6
by c.w. cobblestone
My shoulder throbbed after twenty minutes of scrubbing the tile near the laundry sink, but the damned calcium stain wouldn’t budge. I set down the steel wool pad and tried to stretch my arm, but when I shifted position, a cold wave ran through me and I remembered how badly I had to piss.
I clenched my legs together and choked out a frustrated sob. I knew there was no way I could wait any longer; I simply had to ask for permission to use the bathroom, or I’d surely make a mess.
By the time I’d struggled to my feet, though, I was second-guessing myself, and wondering whether pissing in my panties might be preferable to whatever punishment awaited me if I dared to ask my master’s mother to rescind her order that I ‘hold it’ until one o’clock.
I would have squeezed my penis to try to stop the flood, but it was encased in my accursed chastity device. Instead, I danced in a little circle, debating whether to go upstairs and beg for relief, or just piss myself and accept the consequences.
The decision was made for me; as I did my little jig, my right heel slipped on the wet tile and I fell down hard, severely twisting my ankle. I couldn’t continue holding my bladder, and I rolled around on the basement floor moaning with the warm wetness soaking my panties and the front of my frock. For a nanosecond I felt relief, but that was quickly replaced by the throbbing in my ankle, and the ice that formed in my gut as I wondered what my punishment would be when my masters learned of my accident.
I lay there for maybe five minutes before I was able to rouse myself and wipe up my piss from the basement floor before hobbling toward the stairs. Walking was incredibly difficult with my ankle swelled up to twice its normal size, but I somehow mustered the willpower to make it up the steps.
With tears in my eyes, I stood before my masters, curtsied and started to explain what had happened — but my wife beat me to it.
“You have GOT to be kidding me, standing there with piss all over yourself,” she screamed. “I can’t believe you’d embarrass us like this, you little worm.”
Carla frowned. “Did you get pee everywhere in my basement, Jody?”
With a wobbly curtsy, I shook my head. “N-no, Ma’am, I cleaned it up.”
Demarcus chuckled. “Damn, sissy, this just isn’t your day, is it? That ankle looks pretty bad.”
I curtsied in response.
“What happened?” my master asked.
“Um … I slipped on the wet tile, sir. That’s how I ended up … my accident … I’m so sorry.”
“Don’t apologize to me,” Demarcus said. “My mom’s the one who told you to wait until one.”
I turned to Carla and curtsied. “Ma’am, please … I didn’t mean to disobey you. I really tried.”
“You really tried.” The older woman’s eyes narrowed. “I don’t want to hear your excuses, Jody. You’re the most pathetic thing I’ve ever seen in my life. Now, you can march yourself back down to my basement and finish cleaning — and, no, you can’t change out of that wet uniform.”
“Y-yes, Ma’am.”
“Get your butt back to work.” Carla snapped her fingers.
Following my smart curtsy, I started to limp away, which caused Ron to chuckle.
“Poor sissy; you just can’t catch a break, can you?” he said. “It’s gonna be hard to clean with that ankle swelled up like that, huh?”
Pam waved her hand. “Oh, don’t worry about Jody. He’s happy to make himself useful; otherwise, we’d have no reason to keep him around. Right, Jody?”
“Y-yes, Ma’am, thank you, Ma’am.”
Pam nodded regally. “You can go now.”
“Yes, Ma’am.”
I was halfway down the basement steps when I heard the baby cry, followed by my wife’s annoyed voice.
“Jody! Get back up here; you’ve got a diaper to change.”
With a sigh, I hurried back to the living room as fast as my injured ankle would allow. When Pam spotted my wet dress, she scowled and pointed toward the stairwell. “Go upstairs and put on a fresh apron before you touch my baby with piss all over you,” she said. “And wash your hands. Hurry up.”
I carried out my wife’s instructions quickly before spreading a blanket onto the living room floor and taking the baby from his mom’s arms.
Carla watched as I unfastened Little D’s wet diaper. “Are you sure you trust this pervert around my grandson? From what I can see, the degenerate little creep doesn’t have much in the way of character.”
Demarcus shrugged. “Nah, we’re not worried, Ma. Jody would never do anything to displease us. Ain’t that right, Jody?”
“Yes, sir, of course not, sir,” I said as I put a fresh diaper on his son.
Pam nodded. “Like I told you earlier, I trust Jody a lot more than I would some nanny, any day of the week. Believe it or not, Jody’s not really a pervert. He doesn’t like dressing up like this — not that anyone cares what he likes. But it was Demarcus’s idea. Jody hates it.”
Ron laughed. “Damn, Jody, that must really suck. It’s one thing if you’re into dressing like a girl. But to be made to do it? How do you live with yourself?”
My lip trembled as I struggled to hold back tears amid the onslaught of derision. “Um sir, I … I just love Miss Pam, sir, and I want to make her happy. She fell in love with your son, sir, and like I told you earlier, I begged them to let me stay in her life in some capacity. This is how they want me to be, so I’m just happy they’ve found a place for me, sir, and that’s why I try to be the best maid I can be.”
“Although sometimes you fall short, and disobey orders.” Pam arched her brow. “Like pissing in your panties when you’ve been told to wait.”
“I’m so sorry, Ma’am.”
“Whatever,” my wife said as I handed over her freshly-diapered son. “Now, limp your sissy ass downstairs and get back to cleaning.”
“And I’d hurry up if I was you,” Carla added. “You got a whole lot more stuff to do when you’re done down there. I don’t care how much your ankle hurts.”
“Yes, Ma’am.”
“Normally, I’m not like this,” Carla said, flashing her teeth. “But something about you brings out the devil in me. I’m gonna work you until you drop, you hear? And if your ankle hurts, so much the better.”
“Y-yes, Ma’am.”
Ron smirked. “And we haven’t even talked about all the chores I have lined up for you. Like I said, you just can’t catch a break.”
As I hobbled down the basement stairs, I muttered to myself, “You don’t know the half of it, you hateful old bastard.”

Do you guys ever try to go without protection if you're just staying home for the day? I (23F) tried to do that yesterday because money is tight. I'm inbetween jobs right now because of summer break from college, so I am trying to make my supply last as long as possible until I need to buy more.
I had successfully made it a few times when I got the signal from my body at first, so I felt like I could do it. But I was wrong. I had to change my clothes 3 times and also wipe the bathroom floor each time because they were almost full voids. I figure if I don't try to hold it, then I'm not using those muscles and it will be even harder to control it. I am grateful for my in-unit washer and dryer, though. I cannot imagine how mortified I would feel if I shared a laundry room with other people in my building.
I feel so defeated. I live in a two-bedroom apartment but it's not super big. It's just a short walk down the hallway to the bathroom, but my body cannot hold it for longer than 30 seconds sometimes. I feel like I failed. There are times when I can hold it for longer, like even 10-20 mins sometimes so I try to hold it to like, train my bladder in a way. I feel proud when I'm able to make it on time. I have been trying to stay neutral because I know I can't help this, so I shouldn't reinforce the "good vs. bad" idea on myself.
I feel like I'm doing what I can to get better. I will see a urologist in July. I have been to the gynecologist several times & even urgent care once. I am not able to access pelvic floor therapy because my insurance doesn't cover it. I drink a normal amount of water a day and don't drink much soda, alcohol, or coffee because of money reasons (the health reasons are just a bonus I guess lol). I also just started taking oxybutinyn (5mg), so I'm hoping that will help. I am so nervous because it seems like I will have easier days/weeks with only 1-3 accidents a day, and then I have days where I go through 3-4 pull-ups. I hate that it is so inconsistent and gets worse right when I think I might be starting to get better.
I am starting to gaslight myself into not caring whether I get better or not, so that way if the doctor tries treatments that don't work and can't figure out what's wrong, then I won't be disappointed. I usually feel neutral about it these days, but yesterday was kind of humbling for me. Now I know that I do need to wear protection if I don't want to do extra laundry, clean-up, and feel angry and embarrassed — even just by myself!
I don't know whether I should continue to just wear regular underwear at home & deal with these embarrassing things on my own (and ration my supplies) OR just use my supplies to get through the day & potentially figure out how to get more when I need them.
I just wanted to get this off my chest because it's too embarrassing to talk about with anyone except my therapist. Any advice or kind words are appreciated. Thank you for reading.

About two months ago I started having stomach aches/cramping, changes in bowel habits and a feeling like something was stuck or like I wasn’t done even if I’d just gone to the bathroom or knew I didn’t need to go. I went to a GI about two weeks later and she said it could be colitis or IBS, she called for a FIT test and blood work (both came back normal) and a six week diet (two weeks gluten free, two lactose free and two fodmap). While the stomach pains went away, the changes in bowel and the feeling of something stuck or incomplete did not go away. I had a follow up yesterday and now she has ordered a colonoscopy for a month from now. She mentioned it could be internal hemorrhoids or colitis and also said she’s not worried but still wants to go in and look. Even though she seems unconcerned I am terrified. My worst fear is that it could be something much more serious and that diagnosis is taking too long. My question is do those of you who have experienced similar symptoms agree with her assessment or could my fears be valid and I should do more to get answers sooner? All thoughts welcome, thank you in advance.

My details:
35M, 5’11, 280lbs, Caucasian, confirmed diagnosis of hypertrophic cardiomyopathy (apical variety) and essential hypertension (controlled), currently taking 2.5mg bisoprolol and 7.5mg ramipril, I do not nor have ever smoked, I do not drink alcohol, I do not nor have ever used recreational or performance enhancing drugs, UK.
Context:
I was diagnosed with apical HCM after several heart tests. My ECG is here if it helps. To manage my hypertension and HCM symptoms, I’m on bisoprolol (2.5mg) and ramipril (7.5mg).
I don’t have syncope. I do not suffer from breathlessness during regular activities (but obviously get out of breath if I'm exercising). I sometimes experience chest tightness (not pain) while exercising, however this does not occur if I train in a fasted state (which I find odd). I occasionally get palpitations but no other known heart rhythm issues.
My cardiologist’s care is slow-moving, and I don't have direct access for queries. I need advice on safe exercise with HCM. Post-diagnosis, the cardiologist advised ‘light to moderate’ exercise, but I’m unclear on specifics.
Although overweight, I was previously very active. I did hiking, sprinting, e-biking, and powerlifting. However, since my diagnosis, I've been seriously put off exercise given the risk of SCD with HCM. It is my understanding that walking, hiking, and biking are fine if I keep an eye on my heart rate (target under 140 BPM). I also understand powerlifting and sprinting is out as these are high intensity. However, I’m unsure about resistance training more broadly and would love some advice.
Questions:

1. Is it advisable for me to perform any form of resistance training, considering my age (35) and desire to maintain strength and mobility into older age? While I understand that powerlifting (high weight, low rep, with Valsalva manoeuvre) is off-limits, could I participate in high repetition, lower weight resistance exercises without Valsalva manoeuvre?
2. I’m puzzled about why maintaining an average heart rate of 130bpm during a 30-minute bike ride or walk is deemed safer than a light whole-body weightlifting session that also keeps my heart rate at 130bpm. Am I overlooking a factor other than heart rate that makes certain exercises riskier for someone with HCM? If so, what is it?
3. I appreciate this forum may not be able to provide me an answer at all. However, if you cannot provide an answer to the above two questions, would you be able to tell me if there specific tests or tools that could clarify whether I can safely continue weightlifting with HCM? I’ve heard of athletes with HCM who still compete, suggesting there are methods to assess this. Knowing about these could facilitate a productive discussion with my cardiologist and allow me to request a referral.

I would be grateful for any help you can offer. Thank you.

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

Lately I have been going through more issues with my health.
Fyi, i have Marfans, MVP, Fibromyalgia, Panic Disorder, Heart Palpitations, Frozen Shoulder, lower Back isues, crowded teeth, flat feet, joint pain, low energy.
Recently my mental abilities are getting worse. Sensitive, low pain tolerance, memory loss, slow information processing, brain fog, poor concentration, poor hand eye coordination, lack of eye contact, obsessive compulsive, lost in thoughts, cannot socialize. My wife has given up on me. I keep asking the same questions and i still can't follow. I am a teacher by profession. I lost my mother 2 years ago.
Please help.

We took our 2012 35ix (ZF 8HP45 transmission) out with the trailer (about 3500lbs loaded) this weekend for the first time. My previous tow vehicle was a 2009 MB ML320, which was a diesel with a 7-speed transmission. Between the lower torque with the X5's gas engine (about 100 less) and the 8-speed transmission, I was concerned about how the transmission temp would be. I also have an intermittent issue where sometimes the gate will open up to let me shift into sport/manual mode, but often it won't, in which case I'm stuck using automatic mode and the transmission is shifting as often as it wants... which is really often.
I had to be in full automatic mode for most of the trip, but was able to get into manual for much of the return. Ambient temps were around 20-25C, engine temps were usually 100-110C, and my transmission temps were usually 100-108C. From what I've read, normal operating transmission temp should be 80-100C, with the max allowed for short duration (like climbing a large hill) is 135C.
Interestingly, after I dropped the trailer off and was driving home the transmission temp had dropped about 10C while I was sitting, but once I started driving it rose to the same levels I had while towing and stayed there... so I'm not sure if it's actually getting any hotter while towing than not.
I expected to see a significant difference when I was able to get into manual mode and reduce the number of shifts, but it didn't have much of an impact.
So, I have a number of questions that I'm hoping those of you with more knowledge and experience will be able to help me with.

1. Should I be concerned about my current operating range? I was consistently running a little above the the high end of "normal", and while there were a number of significant hills (southern Alberta), the ambient temperature was lower than it will be when we're doing most of our towing in the summer. I'm not sure if I was over the normal range because the car couldn't cool it adequately or if it was "intentionally" running in that range, since it didn't continue to climb.
   
2. I'm at about 160K km on the car and the transmission fluid hasn't been changed (I bought it this past winter), so I have an appointment with my trusted indy shop to get that done at the end of the month. Will fresh fluid impact the temperatures much?
   
3. When I get the transmission fluid changed, I opted to go with the VF OE oil pan and filter, which is plastic, but several hundred Canadian dollars less than an aluminum model. I've read lots of people saying that the aluminum pan "should" have an impact on lowering the temp, but no real-world input from people who have used both with the same casimilar circumstances. Does anyone know if upgrading to an aluminum transmission oil pan will have a material impact on keeping the temp down and so may be worth spending on?
   
4. I got a VEEPEAK OBD dongle and Car Scanner Pro to read it to see when the torque converter is locked up, but it doesn't seem able to pull that value even though it lists a sensor for it. Bimmerlink doesn't list that sensor, so maybe it's not possible to monitor. I am able to monitor the transmission's output shaft speed and turbine speed, though... am I correct in assuming that if those are the same, the torque converter is locked? Running in 6th gear at around 100km/h both values were often sitting at 288 rpm, but having it there didn't seem to impact the operating temp much. I also read somewhere that when the fuel efficiency gauge is at about 1/2 way or lower (which, on a Canadian model would be 10L/100km), that indicates that the torque converter is locked, but I couldn't find any way to keep it locked in that zone at highway speed with any kind of incline. If keeping the torque converter locked is important, how can I do that and tell when I'm doing it?
   

Thanks!

Hey y'all. I have an appointment next week at a clinic to get birth control, after which I hope to get on testosterone. Currently birth control is my priority because I experience debilitating pain each month that's only getting worse (last month I could barely sleep due to pain, and also it hasn't fully gone away this time where normally I have at least a week or so where I'm not in pain at all; a friend of mine thinks I might have endometriosis). I've also, however, heard the horror stories about trans guys going on birth control and it feminizing them. While I know that this is a question for the doctor I'll be seeing at the clinic, I wanted to ask if anyone had experience with birth control that stops their cycle while not feminizing them. If this is also just some out there pipe dream, I'd like to know as well. Thank you.

The global warfarin market is projected to experience substantial growth, with a notable compound annual growth rate (CAGR) of 2.4%, potentially reaching USD 2,732 million by 2027. This growth is primarily attributed to the rising prevalence of atrial fibrillation worldwide, contributing to an increased demand for warfarin. Additionally, the effective implementation of treatment guidelines related to the management of deep vein thrombosis/pulmonary embolism (DVT/PE) further amplifies the market's growth trajectory.
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Personalized Medicine Approaches: With advancements in pharmacogenomics, there is growing interest in personalized medicine approaches for anticoagulant therapy, including warfarin dosing. Genetic testing for variants in genes such as CYP2C9 and VKORC1 enables healthcare providers to tailor warfarin dosages more precisely, minimizing the risk of adverse events and improving treatment outcomes.
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Focus on Safety and Bleeding Risk Mitigation: Efforts to minimize the risk of bleeding complications associated with warfarin therapy remain a key focus area in anticoagulation management. Strategies such as dose optimization, regular monitoring of International Normalized Ratio (INR) levels, and patient education on bleeding risk factors and precautions are essential for ensuring the safe and effective use of warfarin.
Market Opportunities:
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According to the recent report published by RC Market Analytics, the Global Warfarin Market is expected to provide sustainable growth opportunities during the forecast period from 2024 to 2030. This latest industry research study analyzes the warfarin market by various product segments, applications, regions and countries while assessing regional performances of numerous leading market participants. The report offers a holistic view of the warfarin industry encompassing numerous stakeholders including raw material suppliers, providers, distributors, consumers and government agencies, among others. Furthermore, the report includes detailed quantitative and qualitative analysis of the global market considering market history, product development, regional dynamics, competitive landscape, and key success factors (KSFs) in the industry.
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The Warfarin Market Segmentation:
By Clinical Application:

• Atrial Fibrillation
• DVT/PE
• Others

By Distribution Channel:

• Hospital Pharmacy
• Retail Pharmacy
• Others

By Region:

• North America
• Europe
• Asia Pacific
• Latin America
• Middle East & Africa

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Key Questions Answered by Warfarin Market Report:

• Product popularity and adoption based on various country-level dynamics
• Regional presence and product development for leading market participants
• Market forecasts and trend analysis based on ongoing investments and economic growth in key countries
• Competitive landscape based on revenue, product offerings, years of presence, number of employees and market concentration, among others
• Various industry models such as SWOT analysis, Pestle Analysis, Porter’s Five Force model, Value Chain Analysis pertaining to Warfarin market
• Analysis of the key factors driving and restraining the growth of the global, regional and country-level markets from 2020-2030

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