Not sure if allergies or a cold, but I am supposed to visit my friend and her husband’s newborn baby in two days. I heard zinc and vitamin d which I’ve been taking but anything else? Thanks in advance
Edit: and runny nose***

Hey everyone. First I’d like to start off by saying I don’t really post much/at all and am not sure if this is the right sub or incorrectly tagged so I’m sorry if this is being posted in the wrong place. My mind has been all over the place these past couple days and I feel like I just need some advice.
For context, our dog Nala recently turned 9 years old. She’s a Rottweiler and my family got her the year I graduated college. I was the person who picked her up to bring her home as a puppy and I lived in my parent’s house with her for 4.5 years before moving out with my girlfriend. I couldn’t bring her with me so she stayed with my parents. They moved to another state 2 years ago and it’s roughly 2.5 hr flight away. (I promise this is all relevant)
She started having some kidney issues a few months ago and my parents did what they could to help her with that. She was a bit overweight so they changed her diet to be healthier (less kibble and more natural veggies, cooked chicken, and rice, etc) and she lost around 15 lbs. She was at a healthy weight and seemed to be doing better for a bit.
However, this past Wednesday my mom texted my sister and I that she had to take Nala to the vet because this week she was not doing well. She was lethargic, had nausea, and was not eating normally for a few days. They notified her that she was having kidney failure and basically gave her 2 options. Either try to help her for as long as possible by using a daily IV of fluids which would be extremely expensive, or euthanasia. She was given a week’s supply of the fluid to give her so they could make a decision and have time to see what my sister and I would want to do.
Just a day later (yesterday) my mom texts me that she hasn’t eaten or drank anything all day and is very lethargic and just lays in one of their side rooms all day. My mom said she doesn’t know if she will make it through this weekend.
And this is where I need some advice. I don’t know if I should try to fly down there to see her one last time before she passes or if I should let them proceed so she doesn’t have to suffer longer than she has to. Flying down would be a hassle and expensive on such short notice but I feel so guilty that I’m not there with Nala.
Maybe I’m attributing too many human emotions to her but I feel like I abandoned her in a sense. I was there with her for half her life and then just basically “disappeared”. I mean I was with her since day 1 and while living home was the one who played with her the most and took care of her equally with everyone else. The last time I saw her was 1.5 years ago but she never seemed to forget me even though I saw her pretty infrequently after I had moved out.
What tears me up is that I wonder if there is a part of her that wonders when she’s going to see me again or not. And if she does, then more than anything I feel like if there is a chance that her seeing me brings her a sense of happiness, comfort, a positive distraction from her illness, and I guess in a sense closure in her last days then I’d want to do that for her no matter the cost to me. I just can’t shake the thought of her closing her eyes for the last time and being happy my parents are with her but there being a piece of her mind thinking “But where are you?”.
The other part of me doesn’t want her to suffer longer than she has to so having her endure what she’s going through for another day or so before I can get there feels extremely selfish. Maybe I’m just projecting my feelings on her and my presence would not actually make much of a difference. I just don’t know what to do right now and would appreciate any advice or insight I can get. Thank you all in advance for any help or support you can give.
TLDR: My family dog may not make it through the weekend and I don’t know if I should fly to my parent’s on short notice to see her before she passes or let her go so she doesn’t have to suffer more than she needs to.

I would like to apologize in advance because i know this topic has been done to death.
I have really enjoyed embracing myself in eastern traditions and ideologies recently while i have been on my healing arc / journey. Being more mindful, being more in touch with my feelings and emotions and seperating my thoughts from myself. Its all beautiful and amazing practice.
I thoroughly enjoy psychadelics (psilocybin in particular) and the therapeutic & spiritual benefits they have to offer. I know psychs are kind of frowned upon in true buddhism as is all drug use, but can i be someone who claims to follow buddhism and its practices and ideas, as well as using psychs for spiritual wellness?

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Hello,
I have a neutered male cat thats about 1 yr old now. He's been unable to use his back legs and he's gotten exponentially worse over the past 2 days. He cannot use his hind legs at all now. No appetite either and keeps hiding bc he feels sick.
I have a vet appointment for Friday for further testing, but I honestly don't know if he can make it if I don't take any action from my end until then.
Does anyone know how to prevent this issue from getting worse? Is there anything I can do for him until then? Please please any advice would be appreciated. Thank you in advance.

Species: dog
Age:12
Sex/Neuter status: female intact
Breed: pitbull/lab
Body weight: 53 lbs
History: my dog has allergies and was prescribed prednisone. She's been taking it every other day for about a year. In the last month she lost 15 lbs. She had been drinking a ton of water and peeing on the floor which was unusual for her.
Clinical signs: weight loss, excessive drinking
Duration: 1 month
Your general location: canada
Links to test results, X-rays, vet reports etc:
My dogs blood sugar was 31 at the vet yesterday after getting bloodwork and X-rays. She was diagnosed with diabetes and the vet had blamed the prednisone they prescribed. The vet has instructed to wait two weeks, come back and get insulin injections and a check up. My question is, with her sugar being high, would it be better to request the insulin now and delay the blood curve by another two weeks ? This was an option but the vet said typically wasn't recommended as the prednisone would still be in her system. I am just concerned that within the two weeks symptoms will get worse and I'd rather not have my dog die while waiting.

49 male 5’11” 190 former smoker (smoked approx 20 years, have not smoked last 17) New England served 6 years in the military, 15 years Volunteer Firefighter, 20 years Career Firefighter, 9/11 responder (2 days 9/11&9/12)
Quit drinking almost 10 years ago. Approx 8 months after became fairly ill at home. I could not keep anything down and was sleeping over 20 hours a day and exhausted. Went through several tests with my GP with nothing found. Last test was Western Blot, + for Lyme. Put on Doxy for 60 days sent on my way and told no reason to retest. Felt better and went on with life.
A few months passed and I was run down all the time, wasn’t eating, nauseous, achy and went to an LLMD who ran bloodwork, told me the Lyme had advanced and treated me with supplements and oral antibiotics (heavy duty) I lost approx 60lbs over the next 5 months and not improving so switched to IV antibiotics. I lost another 20lbs in 6 weeks and decided to see another Dr in the area who had experience with Lyme.
This Dr used both traditional medicine and a Naturopathic approach and explained how bad all the antibiotics were and what they had done to my system. Her approach was to boost my immune system and during testing determined I had high levels of 7 heavy metals with Lead, Mercury and Cadmium being the worst. These were treated with Chelation IVs while the Lyme was treated with Vit C and Peroxide IVs, vitamins, and supplements. It was also determined I had the MHFTR gene,hypothyroidism and low T. Put on Methyfolate, Test and prescription thyroid. I completely removed dairy and gluten from my diet. I began working out and gained 50lbs back with much of it being muscle and was feeling great.
I was previously diagnosed with PTSD, Dep, Anx but was managing well and then things went south all of a sudden after almost two years of doing pretty well. I went to a treatment facility and was supposed to enter a first responder program but they determined I was too much of a danger to myself and kept me in a lockdown unit. My Dr convinced me that ECT was the next best step so I endured 18 treatments. I was a zombie for approx 24 hours after each treatment but was doing multiple sessions a week. After drooling on myself for a few weeks I decided this was not the best course of treatment and went to another facility with a Vet/First Resp program and very high end. They treated me medically and for mental health ensuring both were as good as they could be. Adjusted pharma some more and explained how the ECT was not the right treatment and had me do eMDR.
I left the facility and returned home only to have my Lyme symptoms flair again. After several months of treating my immune system again, I was back to work. After 6 weeks I had a mental breakdown, later determined to be from a miscalculated dose from a recall of the Armour Thyroid I was on. It was also determined that my Cortisol levels were high through saliva testing and I was placed on Cortisol Manager 2x dose to lower my Cortisol.
I again returned to work but things were still not right. After a while of this we tested my blood level for Cortisol and I was told I had none. They then tested for Aldosterone and that was very low. I was told I had Addison’s Disease and put on Hydrocortisone and Fludrocortisone. Sent to an Endo, wait 9 months for appt, told there is nothing else they could do and to continue steroids. After another year of telling everyone something was not right I had a cardiac episode with a BP is 192/102 (typically 110/60 and 40-50HR) Saw a cardiologist and out on Olmesartan max dose and Amolodipine(sp?) BP still regularly 160/90. Cardiologist sees Thyroid and Addison testing. Sends me to another Endo. This Drs tests show no issues with Cortisol or Aldosterone and tells me to stop them.
Last week has been miserable. Achy, sore joints and muscles, muscle tension has reduced but posture has changed. Nauseous, no appetite and having a lot of trouble sleeping. My mental health initially improved but has now gone down hill pretty quickly.
Current Meds Luvox 300mg Ativan 1mg 2x day Olmesartan Amolodipine Multi Vit Methylfolate Testosterone
Treatments ECT TMS Ketamine High Dose Ketamine EMDR CBT/CBT Trauma Groups Somatic Multiple therapists with multiple styles
I’ve been on al ot of mental health meds, done DNA testing for meds and this history covers mostly the medical side of things.
Can provide more info or answer questions if needed.

Chapter 1: the event
It was the fall of my intern year as I bean my off service trauma rotation. This month was ubiquitously notorious for being the most labor intrusive and least productive rotaion of our emergency medicine program. Knowing this I entered with the intention of simply surviving the month.
Another intern and I let’s call them A for sake of ambiguity, we’re the first emergency medicine residents to roste on the trauma services that year. A shaky start would be an understatement. In the words of chance the raper “like my grama with the Parkinson’s playing operation.” Would better describe it. Medically we did well. We were very competent and completed our work daily, but communication and coordination was non existent. Our Cheifs had informed us that Tuesday was our day of and the Trauma cheif residents had minimum communication with us, or our Cheifs as it seams when A and I did not report on Tuesday they sternly made their dissatisfaction known.
I have struggled with insomnia sense the age of 10. Had 2 sleep studies by this point in my life and been prescribed nearly every sleeping aid on the market. The 80-94 hr work weeks of our trauma rotaion only worsened my insomnia. My lack of sleep likely contributed to a less than prime adaptive immune system and 2 days out of my trauma rotaion I contracted strep like symptoms with associated nausea, requiring me to call for a sick day the next day. No the first day that I felt too ill to work. I was not fully aware of the reporting process. I reported to my Chiefs, but I did not believe I could come to work tomorrow with amble time and notice, however I was somewhat delayed in letting their Cheifs know, because the surgical chiefs rotated every few days and I did not know who my was going to be the next day. The second day which I had to call out sick I was able to locate the cheif for the next day and reprot according to our university’s protocol, which requires that if a resident feels they are not fit for work they must not come in and the university must have staff coverage without any fear or implementation of punitive actions.
I had finally survived to the last week of my trauma rotaion and I could see the light at the end of the tunnel. What I could not see was the pile of stress, shitty diet, lack of mental well ness and sleep deprivation which I was pushing down to reach the light. By this time I had seen a psychiatrist regularly for sleep medication. I had mentioned to him that I had been experiencing more stressed lately and feel that I might be depressed. he reassured me that it was likely only due to my circumstances, given the difficulty of the trauma rotation and wish to reassess once the rotation was over. Looking back I had to fill the habit of drinking more than I usually do. My only on nights before I have days off became 1-2 beers every other night. All of this repressed unhealthy shit finally pushed bad on September 23rd. That night I was at work even later than usual, I stayed up later than usual and couldn’t seem to fall asleep. With the stress of only having minimal sleep and knowing I only had 2 more days of trauma left, I took an extra dose of my sleeping medication.
I opened my eyes to the fighting sight of sun beaming in my window and I instantly knew I was late. (Sense I hadn’t seen the sun in a month) . Due to my need for scrupulous sleep hygiene I have been sleeping with my phone of and away for me. I rushed to grab it and watched as the little Apple logo seamed to glow on the screen for an eternity. Then in conjunction with its fading I saw 3 missed calls from my director, a text from college A and 2 missed calls from the surgical director. Still, I was able to calm myself, knowing that resident A had been late to this rotation by a few hours 2 other days and nothing came of it. I called my director back and he asked me to report to his office where I was greeted by my director, my coordinator and another emergency medicine facility.
With the only explanation of: “we just want you to get better”, I was handed a letter, to my relief it did not entail my termination, but a declaration of administrative leave and a requirement to undergo an evaluation at a well known university in Florida.
Lake any other savvy millennial, I did my research. By research I mean numerous google searches and screeches thru the depts of redit. To my dismay I discovered that in order for a residency program to fire you, they must first initiate an administrative suspension. I would soon find out however, being terminated would have been a delightful outcome compared to what ensued.
I spend the next few weeks in the wallos of regret and depression. I indulged in higher qualities of alchohol then I ever have before. I all but ceased communing with peers, and abruptly stoped any physical activity I had once enjoyed. Frightened as I was I was ensured, it will be ok “we just want you to get better”
Chapter 2 The evaluation : guilty until proven innocent I did exactly as instructed and scheduled an evaluation, I supposed that this was either a mental evaluation to assess if I’m fit for work with plans of termination or it actually was an evaluation to better treat my insomnia. To this day I regret my ignorance, and wish I had researched the process more. The Hindi / sand-skrt idea of Hamsa 🪬 is that in order to do any good you must have full knowledge or else good intentions can result in harm. I truely believe my director had good intentions, however but him and I did not have full knowledge of the nature of this evaluation.
Looking back see how easily I could have avoided my troubles by asserting legal aid at this point or even by researching this evaluation process more in depth. If one searches impaired practitioner program which I now know this evaluator works for, the search entire will populate 5 or 6 layferms along side their home website and there is a valid reason for this.
If one every finds themself in this process I employ you to bring a DSM to your evaluation or at least be familiar with the most common use disorders in the DSM-5, because your evaluation will turn into a dance of questions where the evaluator attempts to trap you in a round about way to stating something that may qualify for one of the diagnosis. I have provided an image from the DSM-5 below outlining AUD, which the evaluator concluded that I had the most severe from:
Image
Example***** Here are 10 examples of how he fraudulently assessed me taken directly from his assessment note.

1. Evaluator: Have you ever stoped drinking in the last year.

Me: yes I stoped every week day, I was only drinking on the weekends, until two weeks ago.
-Evaluator uses stoping and starting every week to qualify for 2 or more unsuccessful attempts to stop in the last year “There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.”

1. Evaluator Have you ever had withdrawal symptoms

Me no
Evaluator Well Have you ever had a hangover? You know that’s a from of acute withdrawal
Me: yes in college, I had a few but that was years ago and I’m pretty sure the pathophysiology is different.
Evaluator uses this to count for withdrawal symptoms even tho is was more than a year ago

1. Evaluator: Have you even taken your sleeping medication on a day or night which you drank? Me: Yes, I took my prescriptions are prescribed but I never drank close to bed

Evaluator: qualified this as dangerous behavior with alcohol (where the DSM gives examples such as unprotected sex and drunk driving). The sleeping medication I was on is not a benzodiazepine therefore it is not deadly with alcohol. I personally have seen many patients in the ED who have taken their entire bottle of the medication and drank copious amounts, we just monitor them over night and rehydrate them

1. Evaluator Has anyone told you you drink to much or been worried about you Me: No I drink much less than my friends

Evaluator what about your girlfriend? Me: well she actually doesn’t drink at all she doesn’t like it. She often buys me beer for The Weeknd’s tho. One time we went to a movie and she got a little irritated because I waited for beer then complained about them not having any craft beer. So she said, “you couldn’t have just said no” and drank something else. However, she apologized after and said it’s worth waiting if it’s my only day off.
Evaluator said this qualifies for continued drinking despite causing significant relation consequences, ie divorce.

1. Evaluator : you have sleep issues I hear, and your chart says you’ve had depression in the past, don’t you know that alcohol can effect your sleep and mood Me: yes that’s why I never drink within 3 hours of sleep.

Evaluator but you knew this and still drank
Evaluator: qualifies for drinking despite unwanted physical or psychological effects (this should be recurring to effects the alcohol is causing, I have had insomnia sense the age of 10 long before I took my first sip)
7 evaluator you were late for work and told my you had a drink the day before
Me: Yes but I was late because I didn’t sleep and took double my sleeping meds, I will never do that again
Qualifies for 2 significant work or school issues in the past year ( a therapist and other psychologist ensured me that being late on or a few days doesn’t count they typically are getting fired or failing) ( moreover, this would assume I was late do to drinking it’s self and also assume if happened more than once)

1. • Alcohol is often taken in larger amounts or over a longer period than was intended

He never once asked anything related to this question yet said I qualified in his final report 9. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. The evaluators logic here was sense I was late for work and I had 2 beers the day before I must be taking long to recover from it (this is assuming I missed due to alcohol)

1. Tolerance drinking more to require the same effect: this he checked as true in his final note however it was never even discussed in our evaluation. I did mention to him that I’ve been drinking more than I had earlier in the year frequency wise, but they said nothing to do with quantity or needing more.
   
2. Wanting to drink so bad you can not think of anything else: this is the only qualification of SAUD my evaluator said I did not have.
   

Moreover, without legal help I was not aware that I could obtain a second evaluation or even oppose going to get evaluated at all, but that wouldn’t have mattered seeing I still thought this was for my health and wellbeing as seen when I was asked why do you think you are here to today, to which I replayed “so that I can be evaluated to see what is needed to get back to work”.
To maks the ordeal more infuriating the evaluator continues to ingratiate himself and lie through the process telling you, “it will be fine as long as you are 100% honest”, “anything you say in here is between you and me” or “you slipped up once with your meds, I know your residnecy program they will probably just want a few more out patient tests”
Two weeks later I received a phone call right before I left for an out of state vacation to visit my nice for her birthday. During the call I was informed that I would be required to complete a partial hospitalization program (PHP) lasting “6-10 weeks” which would coast from 15-50 grand not including doctor visits or housing which is billed separately. I suppressed this inconvenience, enjoyed my vocation and reported when I returned, knowing that I must complete this soon so I may return to work with due to the fact that my payed time off would soon be diminished. At this time I had not yet heard of the organization PRN.
Chapter 3 Guilty till proven innocent: The diagnosis
Shell shocked I arrived to a in patient psychiatric unit and was rapidly cleared to progress to treatment without detoxification. During my 90 day of forced rehabilitation I met a few other individuals who were unjustly and fraudulently forced into treatment. I began to look up to one of these such members of the men’s community, who I will refer to as patient X for ambiguity sake.
Unlike me patient X did have alcohol use disorder. He spent many clinic days drinking to avoid alcoholic withdraws. The curious component of his story is that he admitted his depravity, saught help and through his own journey became sober. The bodies at be, namely his local physician, Health monitoring program, rejected his personal path to sobriety and forced him to undergo 90 days of in patient treatment before he could practice medicine again. When he checked in to rehab he had been sober for over a year.
Ask for Stories of people from online
As for me I spend many sleepless nights pondering how consuming a legal substance in a moderate amount could throw me into significant legal financial issues. My labs my toxicology, my story and my collateral from colleagues from colleagues all indicated light to moderate alcohol use but my evaluators word stood as the word of God.
More frightening was the director of this rehabs acknowledgment of this. The director who happens to also coincidentally be the evaluator, stated to me as well as to staff on multiple occasions: “ I suggest inpatient treatment for everyone who is reported”. “This is safer for me not to miss anyone who could harm patients, and I figure there must be a reason someone reported them.”
I am still elucidating the reason why I was determined guilty and proven innocent, however I can say from my 90 day stent that the majority of the patients at this rehab needed to be there. This program is saving lives of both providers and patients, however it is destroying the lives of those wrongfully accused.
Chapter 4 your lisense rehab or jail : Upon arivil I was sent to a detox hospital underwent a medical examination and was “one of the lucky ones” who required no detoxification and could report directly to PHP. Like everyone else, I spent 90 days in a PHP, being as 6-10 weeks is simply a lie they tell patients to decrease the change of resisting the treatment. When discussing the topic one therapist sated “if we told patients 90 days they would never come.” She then attempted to justify the treatment by outlining the story of a patient she had called who “didn’t make it to treatment” and killed themselves”. It is my belief that it is not the lack of PHP which impelled such professionals to take their life, but them realizing that they now will be obliged to undergo 90 days of PHP, 5 years of PRN monitoring with a loss of autonomy and hundreds of thousands of dollars taken from them that induced their hopelessness. For even if these professionals were truly mentally unstable in their addictions, in every case it was only following a phone call where they were informed they must undergo treatment that they took their life’s. By this time I still haven’t the slightest clue what PRN was.
Despite the security these programs provide for many my 6 main issues with them can be summarized in : 1. Kick backs: evaluators are directors of treatment clinics 2. The reported are guilty till proven innocent 3. The price, the overflow of money these places drag in from both patients and state universities is appalling, they charge separately for every visit and test 4. Although they make the claim that they are individualized, they are anything but. Every patient gets the same stay and treatment from the doctor drunk on the job and the one who was late to a shift 5. They force voluntary treatment. remember that friendly evaluator who promised he had your best interest at heart, so you opened up and told him everything about your substance use/ developmental / family history, well if you don’t stay for 90 days he will be “normally obliged” to tip the board of medical off to you.

1. The programs have overstepped their intended jurisdiction. -these programs work well if they function how they were intended at their inception. Cite original purpose. Originally these programs were designed to protect physicians and civilians from impaired practitioners; being healthcare workers who were impaired at work. Over the years, these organizations have extended their authority to encompass individuals with substance use disorders When not at work and also those who are in training to become healthcare professionals. Take for example myself compared to a physician who is impaired at work. A doctor who arrived for duty under the influence would surely benifit from the extensive testing, therapy and accountability enforced via these programs. In accordance the 20,000$ per year cost is appropriate when only making up roughly 7% of their yearly salary vs nearly half of a residents. In my case with my loss of income from employment, coast of treatment and monitoring, this year I will be required to pay 20,000$ to work. Yes, I will be losing money to work. Even if did indeed have a substance use disorder this level of monitoring wouldn’t not be considered appropriate.

Dispite all of the miscomings of this System My time spend in PHP was indeed helpful, as I believe it would be for anyone. Time for exercise, a reprieve from work and weekly counseling. A sample structure of my day to day schedule is provided below for insight:
Structure The general structure of these rehabitation centers is as follows: 1. One week of orientation phase, where you are not allowed in electronics or contact with the outside world world. Therefore, if you’re going, bring some things you would like to read or study. 2. In phase 2, you can use your phone however you cannot leave campus. You must stay in the dorm on campus. These shitty 1 room run down apartments with two other roommates will cost you about $1000 a week, they are required for at least four weeks and they are billed separately, no insurance will help you out here. 3. In phase 3 you can commute to campus if you beg your therapist and live very close. Whether you’re on campus or living off-campus, you are allowed to leave up to four hours per day. If you commute, you’ll be required to take a sober link decide you must Breath, alcohol test into every 6 hours. Like everything else in this program you must pay for this separately, a few hundred dollars a week. You advanced to other phases by completing assignments, however, assignments are limited by required built-in time, intrusive, scheduling, and reviewing. Therefore, if you do everything as rapidly as possible phase 1 will take one week phase 2 will take three weeks.
Every day schedule:
7:30: wake up, report to the front desk to inform them that you haven’t ran away yet and take and prescribed medications. They keep all your medications and require that you report to take them; for me this was antidepressants in an attempt to dispel the depression I contracted from being forced into treatment and whatever off label medication they were attempting to treat my ADHD with, since control medications were forbidden.
8 am: community group assessments This consisted of other patients presenting their assignments amongst the large group, on the weekends this was often an hour later and 12 study regularly took the place of assignment presentation.
10 am: process group. This was a two hour group therapy session with 6 to 12 other professionals in a therapist and training or occasionally a licensed mental health therapist.
1 pm: recreation This was generally about an hour of some sober themed craft or activity. Once a week this time slot was used for yoga.
2 pm: this was another time slot used for patients to present assignments as well as for individual therapy sessions. Each patient had one individual therapy session lasting 30 minutes per week.
3pm: This was time allotted to work on assignments or go to the gym on your sex specific scheduled gym day.
5pm: this time was used for guest speakers or another 12 step study group.
6 pm : this was generally an off-campus 12 step group
10 pm: report to the front desk and let them know you still haven’t ran away and take and Medication which are prescribed to take at night, then return to your cot bed in your room with 1-2 other roommates.
I found the community to be one of the most beneficial aspects of the PHP program. I was in a cohort of chill ass professionals of the same occupation who were always there to help each other.
Assignments The curriculum of the PHP consisted of assignment based on every step of the 12th step program. Generally, a patient would be required to complete an assignment on their own, review it with other patients, then faculty and finally present the assignment in front of the whole treatment group. You’re only given one assignment at a time and there are multiple steps to each which all requires scheduling this ensures that no matter how determined a patient is a full 90 days of treatment is required to complete all the assignments.
AA structure -the obsolete nature of AA has been verified in numbers studies, but I will refrain from divulging here and lend that endeavor to Dr. Lance Dodes very thorough discussion on the subject,in “the sober truth “
In all sincerity, if I truely did have a severe use disorder this experience could have been life saving. I only wish I could have used my 50 grand for someone who has spent their life time In addictive without reprieve. My first conversation when I was given my phone back was how I wish my father could be able to attend this PHP.
Chapter 5 reporting and PRN Self reporting What they ask you What you should tell them
There’s a third-party agency called professional resource network. Every state has their own. This agency works as a liaison between you and whatever credentialing service your occupation requires. Essentially they ensure your monitoring after treatment. Stake governments and licensing boards trust them, mainly because they monitor with the highest level of intrusiveness. This alleviates much work for state governments and licensing boards because once an individual is being monitored by a professional resource network, then they are deemed appropriate for duty and no further investigation/litigation needs to occur, as long as the monitored individual completely complies.
Because I was never impaired at work I was never reported to this agency. The general workflow of things someone would report you to professional resource network, then the resource network would contact you, and then you would be required to report for an evaluation at a treatment center, which would inevitably result in a suggestion I’ve treatment at that given treatment center. In my case I was sent to the treatment center without PRN being involved. Thus, two weeks into treatment. I was notified by my therapist that I needed to call PRN and self report. I attempted to resistance given that I did not have a problem and was not individually seeking help. I asked what happened if I didn’t self report. I was told that in order to stay in the treatment program I had to report to PRN. This meant either I report to PRN or I get kicked out of the treatment program and lose my job.
When you report to PRN they will ask you why you are in treatment. They will then list off every substance imaginable, asking you if you have ever tried the substance and when your last use was. Ultimately, they will obtain your discharge information from your treatment center, so it is in your best interest to report only what was found in your biochemical testing. If it wasn’t in your hair, I would argue that you don’t have a use disorder regarding that substance and it’s not relevant. I don’t believe it’s important for them to know that you smoked weed when you were 12.
Chapter 6 The contract:
Before being discharged from a treatment facility, a professional resource network will have you sign a contract. A little known fact which I was oblivious to is that contracts can be negotiated. Though this isn’t it possible, it is highly improbable that you can negotiate your contract since PRN has a power to delay your clearance to return to work.
Contractor almost never personalized, and I have not heard of a contract which is not a five-year agreement. You will sign releases of information so that PRN has access to all of your information which was gathered at the treatment facility. You must have a therapist, psychiatrist, primary care, doctor, and a addiction, medicine psychiatrist. You assign releases of information for all of them. You will be required To commit to: 1. three mutual aid meetings a week which you must log. I log smart recovery meetings. 2. Weekly therapy sessions with an approved mental health therapist from their list 3. Monthly doctors appointments with an addiction medicine psychiatrist 4. Yearly appointments with a primary care physician 5. Monthly appointments with a psychiatrist 6. Daily check-ins on a random drug testing app ( you will agree to weekly urine tests, a peth test 4 times a year, a hair test twice a year and a little caveat that says anything else they deem, clinically reasonable) 7. Quarterly update reports which you are required to obtain from a workplace monitor, therapist, addiction, medicine, psychiatrist, primary care physician and any other doctor you are seeing. 8. You must upload all of your prescriptions into a mobile application every single time you get them refilled and are not allowed to take them until they are approved. 9. Attendance of a PRN group via zoom. This is a local group you are assigned along with other monitored practitioners. There is a fee of roughly 130$ a month to attend this required group. For me all of these requirements coast around 20,000 a year. If you ever have a positive test even if it is the result of contamination from rubbing alcohol or unintentional ingestion of alcohol/ allergy medication your contract will rest to 5 years from the time of positive test. Once your five year contract is completed, you must ask to be released from monitoring. At that point they will search for any reason to keep you under monitoring. This could be dilute urines, daily check ins or a week where you did not attend mutual aid meetings. Every certification and license which you apply for will likely ask you if you were under a monitoring program/ have been treated for substance use. You must give an explanation and check yes. As far as licensing programs are concerned, if you were under the monitoring of PRN, you are safe, however they group practitioners who have had behavioral issues with practitioners who were diverting drugs from work. Therefore, keep in mind that you will be labeled as a sever addict.
7 Back to work and only work. During treatment your only goal is to return to work, however when you return your experience will be drastically distinct from what you remember. For me, I was now working in isolation. Missing six months of my training meant that no other Resident was on the same rotation as me. My coworkers at all formed friend groups. When I returned I was greeted with much concern for my well being. No one would speak to be about my absence, however everyone knew there is only one reason a resident would leave for 6 months then return. My Accdeemic meetings were consisting of attending telling me “I have a target on my back now” and “ I have to preform even better than others” in the light of my time missed. If this wasn’t alienating enough, the majority of Resident events, sponsored by recruiters and my university revolved around alcohol to which I had to give some excuse to why I can not partake with others. I’m fortunate that I do not have an addiction, because these stressful conditions along with the daunting amount of dead and requirements imposed by PRN are enough to make any addict relapse. While I was at treatment, I was in the dative with Samyr stories a physicians whose addictions got the best of them. Physicians who did not make it to treatment, often taking their own life. These stories were presented as a warning. Your addictions will kill you without our treatment was the message. When, in reality I did not hear one story in which the addiction killed physician. Every physician who didn’t make it to treatment took their life after being told they must report to a treatment facility. Perhaps they knew what this entailed and it was not their addiction or getting caught which caused them to end their lives, but the unmanageable and often unreasonable burden that treatment would put on their lives.
9 How to escape So your fucked your in PRN and should be or you should and now your recovered and want to terminated your contract.

1. You ask to be released early done at 1/2 time ( good luck)
2. You have “good reason” (no one has ever been let out of contract because of this reason, the verbiage is far too vague)
3. You serve all your time and they let you out(maybe, as discussed earlier, they would do everything they can to keep you in your contract as long as your practicing)
4. You can’t practice medicine anymore

10 Layer up butter cup : I cannot emphasize the extent to which legal help is required in this process. You much seek it and seek it early. Lawyers can provide many avenues to you early in the process. Once you have committed to treatment, gone for evaluation or are in a PRN contract , this is very little that you or legal help can do. Spend a few thousand dollars when you are accused and save the 20-30,000 later.
After you have been evaluated if you disagree as I did, then this is the process you must undergo. 1. Hire a occupation, defense, lawyer 2. Prove you don’t have an addiction, this is done by having an alternative evaluator with similar credentials state that either you don’t have an addiction or that PRN’s level of monitoring is not medically appropriate ( this will need to be a multi day neuropsychological evaluation, which will cost about $5000). 3. Your lawyer must draft in writing that the medical level of monitoring is not required such as another medical professional and send this to PRN 4. PRN will tattle on you to the board of medicine. 5. The board of medicine will conduct an investigation. 6. At the end or when they believe they have enough reasonable evidence to the board of medicine will suspend your license or claim, you must comply with the PRN contract to practice. 7. At this time your lawyer will defend you in the state court against the board. This is costly but much less than the coast of a 5 year PRN contract 8. If you win you will likely suggest an alternative level of care such as gonna get therapy every week. If you lose, than you wasted a fuck ton of money and are still bound by your PRN contract.
Overall this entire process has coast me Over all coast:
My finances for this year only including PRN and rent are as follows:
120-200$ every week for testing 480-800/ month
65 every week for therapy 195/month
125 every month for PRN group
About 50-69 every month for 2 doctor apts
So at least 745$/month at the lowest
Treatment at the recovery center coast 20,000 for me out of pocket and
I wasn’t payed for 6 months with no FMLA because I am a first year. At the 1 year mark I will have made 26,000 this year after taxes And payed About 29,000 on PRN alone
Rent is 1,000 so that’s 12,000 a year
Just in rent and PRN alone I will be at 26,000- 41,600 -15,600.
I will be in debt by at least 18,000 at the 1 year mark
Coast of treatment center 20,000 (with insurance) For each year of PRN roughly 20,000 Add that to 6 months of attending salary which was delayed due to my treatment time: at least 150,000 Layer coasts along with other evaluations 25,000 Missing 6 months of residency pay 30,000 Coast of 1 year in monitoring: 245,000 Coast of 5 years 325,000
If my case progress to a trail I will require an extra 20,000 in court coasts
Chapter 11 My secondary eval: Dr sushi After I arrived at my treatment center I challenge my evaluation multiple times. Each and every time I was discharged and often accused of alternate mental health/ substance abuse issues to discourage my advances. I was never given the opportunity to undergo alternative assessment, however PRN guidelines state that you can obtain a second option within 7 days of your first. This is a mute point, however, because you will not receive the results of your evaluation until over a week after it is conducted and the second evaluation must be conducted by another PRN hired evaluator of their choosing. During my stay in rehab I contacted PRN multiple times to attempt another evaluation/ legal help. They warned against both stating they were a “waste of money” and “pointless”.
After completing my treatment with the guidance of many addiction, experienced physicians, mental health counselors and psychiatrists recommendations I sought in a secondary evaluation. I chose a highly qualified professional with over 30 years of experience to conduct an extensive neuo psycho social evaluation of me. One that I was sure would be more extensive than the evaluation I received at treatment and more importantly an unbiased evaluation.
The results from my evaluation not only showed that I did not have a substance abuse problem warranting PRN level monitoring, but also that PRN was falling to allow adequate treatment of other conditions such as my ADHD. My evaluation showed my ADHD was not only untreated by PRNs attempt at using non controlled medication, but also in the top 3% most severe presentations of ADHD. My evaluator went on to explain my results by questioning why my treatment center even mandated I undergo neuro cognitive evaluation. The only neurodiverse findings were my IQ, my dyslexia and my ADHD. However, a neuo cognitive examination can be billed separately by treatment centers, therefore they always recommend one.
Chapter 12 Amongst its greed, intrusive nature and faulty accusations, professional recourse network function highly proficiently at the task they were designed to; protective physicians and patients from physicians who are impaired at work. In this domain they save lives, offer second changes and protect the public. When they act beyond their intended jurisdiction by imposing unnecessary monetary demands on practitionersin training, accuse practitioners without proof or act on behavior exemplified outside of a work setting they unjustly and inappropriately attack the week and innocent.
Proposed reform: As a trainee my universities malpractice insurance covers me for mistakes made at work. If a learner mistakenly harms a patient, then the university stands on their behalf. If the learner does something wrong under a teachers direct guidance, then the teacher is at fault. This makes sense logically as well as pragmatically. The state entrusts large amounts of money to hospital systems and universities to train resident physicians. A portion of this money is allocated to malpractice insurance. This should extend to accused impairment.
Suppose a training university was required to cover rehabilitation and monitoring of a resident of whom they claim is impaired. Alternatively they have the option of firing the trainee. This would reduce the number of innocent trainees being accused of impairment, make the process of rehabilitation more fair and provide a better use for tax payer derived dollars, which hospital systems are given to train residents. The truly impaired could still seek help, less false accusations would be made and with the employers having the ability to fire at the moment of impairment, there would be less chance of impairment at work.

I F27 had sudden onset chronic pharyngitis December 2023. I haven’t gone more than 2-3 weeks without being placed on antibiotics (which would temporarily clear the issue). I’ve had cultures, a million strep tests, mono, flu, covid, tried allergy meds, etc. I’m infected with nothing, yet the inflammation and fever keeps coming back after I stop the abx. I was supposed to have my tonsillectomy to attempt to ‘cure’ the pharyngitis at the end of April, but my dog was hit by a car. He had some crazy surgeries and has been incredibly hands on for both me and my spouse in terms of care.
I rescheduled my tonsillectomy as I’m now on antibiotics for the millionth time. It’s next week and I’m so scared. I’ve had to sleep separate from my spouse because they have to stay with the dog and I have a bad back so I have to sleep in the bed. I’m terrified of hemorrhaging and not being able to reach them. Or of hemorrhaging and the pup refusing to go in the crate delaying my access to care. Edit to add: my tonsils aren’t very big at all. I’m not sure if that reduces my risk. They’re a bit cryptic now after the chronic inflammation, but when I’m asymptomatic they’re quite normal in size.
Every link on google says a wildly different number for likelihood of hemorrhaging—20%, .028%, 5%, 11%. I can’t even get a good grasp on my risk, let alone how to handle it if it happens. I’m paying a 20k vet bill, I can’t afford an ambulance ride to the hospital as well. All I see are horror stories every time I just try to see someone else’s recovery.
I want to cancel the tonsillectomy, my ENT isn’t even confident it’ll work. I feel like if I cancel again they’ll fire me as a patient. I’m sick every two weeks, I don’t know what to do.
Are there any non eventful adult recoveries?

KEY POINTS

• The therapeutic interactions between doctors and cannabis patients can be extremely gratifying.
• Having time to deeply explain and then followup with cannabis patients and caregivers creates a special bond.
• Working in the world of medical cannabis is provocative and challenging as more is learned about the plant.
• People's interactions with cannabis provoke a fascinating mix of medical and spiritual benefits.

Working with patients and their families for the past nine years as a medical cannabis practitioner has been extremely gratifying in many surprising ways.
After 30-plus years in the ER and urgent care setting, providing one-time, episodic interventions and rarely seeing the same patient again, I now have accrued a roster of hundreds of ongoing patients, many of whom I have continued to treat since I began as a registered cannabis practitioner in 2016.
The conversations we have, mostly about their positive responses to using medical cannabis but about so many other aspects of life, politics, and their illnesses, have become a very important part of my own life. These dialogues have brought me closer to the patients, their families, and their caregivers and have been instrumental in my ever-deepening understanding of and appreciation for the vast array of benefits that medical cannabis provides.
It’s been a tremendously important and enriching experience and, in addition, has rekindled my interest in biochemistry, neurotransmitters, and brain anatomy, subjects that I last explored during medical school.
Most remarkable has been the array of patients I’ve met who have taken me into their lives. Advising patients about medical cannabis has brought me into contact with a stratum of people I would otherwise probably never have access to. They have ranged from corporate CEOs, attorneys, and others wanting a medical cannabis card so they wouldn’t get arrested with illicit products to people with devastating and debilitating autoimmune diseases or those with terminal cancer.
Regardless of where along the health and socioeconomic spectrum my patients lie, there has been a consistent attitude that I became aware of early on when the law legalizing medical cannabis first went into effect.
I’m referring to an openness to trying cannabis. These patients, their families, and their caregivers haven’t been taken in by the nearly 90-year-old propaganda onslaught against the plant. Either they laughed at the “killer weed” characterizations, were open-minded enough to see or know others for whom it worked, or, especially in the many elderly patients I see, they’d already tried everything else before they came to me. They clearly had not gotten relief for an array of symptoms caused by their underlying diseases and were willing to give medical cannabis a shot.
As they have seen its benefits, this has formed a unique bond between many of us, an understanding and camaraderie in that we are partaking in something still considered forbidden and illegal in many corners of the globe. Yet we know that despite that condemnation, we have access to something that, as so many of them say, is “life-changing.”
I had realized early on in the ER and Urgent Care setting the need for abbreviated interactions. The conversations and observations that transpired in those settings helped my interventions there to provide the best immediate therapeutic relief. Even though they were often brief (of necessity), these experiences also led to many of the stories I wrote and were published. Now, in this late-in-life career choice, the longer conversations that I can pursue provide me incredible insights into the workings of the cannabis plant and provoke me to try to understand what I’m being told by patients or their caregivers about their observations on what taking cannabis is like.
I seem to learn the most from my “cannabis naive” patients, those who have never used the plant. They will describe the process of finding that “sweet spot,” discovering the therapeutic regimen that gives them the relief they seek, bringing them back to where they’d been before their illness struck. And, whether this happens in a day or a week or longer, the story is similar to hearing someone describe an epiphany.
I can no longer count the times I’ve been told: “I now go through the day without pain and have to remind myself that it’s from the cannabis tincture I take every morning.”
I’m reminded of a patient who’d come to me for treatment of severe chronic back pain. When I asked, with concern, how the high THC product he took every morning for that pain affected him at work, he recounted how, as a computer programmer, he was tasked with coming up with solutions to various program challenges. He told me that using cannabis allowed him to find answers he would not have seen otherwise.
Or the successful businessman with Crohn’s disease who, before using cannabis at work, would be debilitated by his flares. Now, four or five years into his involvement in the program, when he senses a flare coming on, he uses a very well-controlled dose of his high-THC cannabis, and shortly thereafter, he dives right back into caring for his customers, pain-free and focused.
I also have a patient with USHER 3 syndrome, a degenerative disease ultimately causing deafness and blindness. She has compared her taking cannabis to being in a dark room and having the lights go on.
Several patients with severe pain syndromes, overweight and out of shape (and scheduled to have surgery for resolution of their symptoms), have found that as cannabis increasingly resolved their pain, they became more active, lost weight, had even less pain, and ultimately (for several, now six or seven years into using cannabis) have been able to avoid going under the knife.
I have another patient, a writer with severe anxiety and some cognitive issues, whom I saw recently in follow-up, a year into treatment with cannabis. She is much more focused, conversant, and happy, interacting with family and caregivers in a much more positive way, and no longer abusing alcohol.
Another, a teacher with Autism Spectrum Disorder, told me he has been able to escape the destructive route older generations in his family had chosen, using alcohol to try and treat their symptoms. Instead, he has adopted a cannabis regimen to effectively control his ASD.
I also must mention the great help my colleagues and I are seeing that cannabis can provide for many of the symptoms of dementia.
It is my hope that those of us practitioners in the world of medical cannabis can continue to educate the public and break down the stigma surrounding cannabis. Hopefully, as well, governments will move forward in rescheduling (or de-scheduling) cannabis so that more patients can benefit from its therapeutic potential.
This brings me back to my last patient and the question about THC and wisdom:
I recently saw a middle-aged man, a Hasidic Jew, with inflammatory bowel disease. He found that medical cannabis could be very helpful in controlling his IBD flares. In addition, when we were on a follow-up call a few months after he began taking medical cannabis, he asked me something.
“Dr. Weinberg,” he asked, “does THC give you wisdom?”
I was intrigued by the question and asked back, “Why, what do you mean?”
“Well,” he said, “I’ve been reading Talmud all my life, and there have always been passages I don’t understand.” He paused. “But when I take my medical cannabis, and I go back to my studies, I get it! I understand the meaning of those passages. And it’s not because I’m high! Both my wife and the rabbi agree that my insights are valid and profound.”
Knowing the many references to cannabis in ancient Hebrew (and other spiritual) texts, I shouldn’t have been surprised at his question. I was delighted, however, and am eager to pass this insight along to others as we hopefully advance our knowledge of the many benefits of the cannabis plant.

Imagine being prescribed a life-saving medication only to realize that its cost could drain your savings in a matter of months. This is the harsh reality for millions of Americans, who are forced to navigate a healthcare system where the prices of prescription drugs have reached astronomical heights. The issue of high drug prices is not just a matter of economics; it is a moral and ethical dilemma that affects the very fabric of society. This essay will argue that the exorbitant cost of prescription drugs in the United States is unjustifiable, driven by corporate greed and inadequate regulation, and propose viable solutions to ensure that life-saving medications are accessible to all.
To understand the gravity of the situation, one must first comprehend the extent of the problem. According to the American Journal of Managed Care, the average cost of prescription drugs in the United States is significantly higher than in other developed countries. For instance, a 2019 study by the House Committee on Oversight and Reform found that U.S. prices for the 50 most commonly prescribed drugs are nearly four times higher than in comparable high-income nations. This disparity is not merely an economic inconvenience; it is a life-threatening crisis for many individuals who cannot afford their medications. The high cost of drugs forces patients to make unimaginable choices between their health and their financial stability, often leading to poorer health outcomes and increased mortality rates.
At the heart of this issue lies the pharmaceutical industry's insatiable greed. Drug companies often justify high prices by citing the enormous costs associated with research and development (R&D). While it is true that developing new medications is an expensive endeavor, this argument loses its validity when one considers the profits these companies generate. A 2020 report from the Institute for New Economic Thinking highlighted that pharmaceutical companies consistently rank among the most profitable sectors in the U.S. economy. The same report noted that these companies spend more on marketing and lobbying than on R&D, indicating that profit, rather than innovation, is their primary motivator.
Moreover, pharmaceutical companies exploit the patent system to extend their monopolies on drugs, a practice known as "evergreening." By making minor modifications to existing drugs and obtaining new patents, companies can prevent generic competition and maintain high prices. This manipulation of the patent system undermines the very purpose of patents, which is to encourage innovation while eventually allowing for affordable generic alternatives. The result is a market where essential medications remain prohibitively expensive long after their initial patents should have expired.
The regulatory framework governing drug prices in the United States is another significant contributor to the problem. Unlike many other countries, the U.S. government does not regulate the prices of prescription drugs directly. Instead, it relies on market forces to determine prices, a strategy that has proven ineffective in a market where consumers often have no choice but to purchase life-saving medications regardless of cost. The lack of governmental intervention allows pharmaceutical companies to set prices at whatever level they believe the market can bear, often leading to exploitative pricing practices.
Additionally, the lack of transparency in drug pricing exacerbates the problem. Patients and healthcare providers frequently have no clear understanding of why a particular drug costs as much as it does. The pricing process is shrouded in secrecy, with drug companies rarely disclosing the factors that contribute to their pricing decisions. This opacity makes it difficult for consumers to make informed choices and undermines efforts to hold pharmaceutical companies accountable for their pricing practices.
Addressing the issue of high drug prices requires a multifaceted approach that includes both regulatory reform and market-based solutions. One of the most effective measures would be to grant Medicare the authority to negotiate drug prices directly with pharmaceutical companies. Currently, Medicare is prohibited from negotiating prices, a restriction that puts the U.S. at a disadvantage compared to other countries where governments negotiate prices on behalf of their citizens. Allowing Medicare to negotiate would leverage the program's significant purchasing power to secure lower prices for millions of Americans.
Another crucial step is to reform the patent system to prevent evergreening and encourage the timely introduction of generic drugs. This could involve stricter criteria for granting secondary patents and reducing the duration of market exclusivity for drugs that do not represent significant therapeutic advancements. By promoting genuine innovation and preventing patent abuse, these reforms would facilitate greater competition and lower prices.
Improving transparency in drug pricing is also essential. Legislation that requires pharmaceutical companies to disclose the costs associated with developing and marketing their drugs, as well as the factors influencing their pricing decisions, would provide much-needed clarity. This transparency would empower consumers and policymakers to make more informed decisions and hold companies accountable.
The issue of high drug prices is a complex and multifaceted problem that requires urgent attention and decisive action. It is driven by corporate greed, inadequate regulation, and a lack of transparency, all of which contribute to a healthcare system that often prioritizes profit over patients' well-being. By implementing regulatory reforms, promoting competition, and enhancing transparency, it is possible to create a more equitable system where life-saving medications are accessible to all who need them. The time to act is now, before the cost of survival becomes too high a price to pay.

The global dishwashing products market size was valued at USD 39.78 billion in 2023. The market is anticipated to expand from USD 41.76 billion in 2024 to USD 60.27 billion by 2032, exhibiting a CAGR of 4.7% during the forecast period of 2024-2032.
Essential for kitchen cleanliness, dishwashing products, including detergents, scouring pads, and wipes, ensure effective removal of grease and stains, promoting a hygienic environment for kitchenware. The increasing demand for kitchen utensils, cookware, and dish plates among households is a key factor propelling the market, as evidenced by Groupe SEB's significant 9.1% quarterly increase in net sales in Q3 2021.
The increased inclination towards purchasing dish cleaning products in bulk during COVID-19 lockdowns globally elevated product consumption, mitigating concerns of shortages amidst pandemic-related restrictions.
Fortune Business Insights™ provides this information in its research report, titled “Dishwashing Products Market, 2024-2032”.
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Top Companies Covered in the Dishwashing Products Market:

• The Procter & Gamble Company (U.S.)
• Unilever plc. (U.K.)
• Henkel AG & Co. KGaA (Germany)
• Reckitt Benckiser Group Plc. (U.K.)
• Colgate-Palmolive Company (U.S.)
• Amway Corporation (U.S.)
• Ecolab Inc. (U.S.)
• Jyothy Labs Limited (India)
• McBride (U.K.)
• 3M (U.S.)

Segmentation:
Ancillary Segment Holds a Major Market Share owing to the Rising Demand from the Restaurant Industry
In terms of product types such as ancillary products and dishwashing detergent. Ancillary products include brushes, sink cleaners, rinsing aids, scrubbers, wipes, and scouring pads. The ancillary products segment captures a major dishwashing products market share. This is driven by the high demand for brushes, scrubbers, and rinsing aids in restaurant settings.
Residential Segment Secures a Major Market Share owing to Priority for Household Cleaniliness
In terms of applications, the market is segmented into residential and commercial. The residential segment captures a major market share. The is driven by the significant demand for detergents as households prioritize cleanliness.
Hypermarkets & Supermarkets Segment Dominates Owing to Diverse Cleaning Supplies Availability
In terms of distribution channel, the market is segmented into hypermarkets & supermarkets, convenience stores, online channels, and others. The hypermarkets & supermarkets segment captures the key market share. The segment witnesses substantial growth as these outlets offer a wide range of cleaning supplies, meeting diverse consumer needs and preferences, fostering market dominance.
In terms of region, the market is categorized into Europe, North America, the Asia Pacific, South America, and the Middle East & Africa.
Report Coverage:
The dishwashing products market research report thoroughly analyzes product types, application areas, distribution channels, and leading companies, offering insights into current market trends and highlighting significant industry developments.
Drivers and Restraints:
Rise in Smart Dishwasher Adoption to Spur Market Growth
The proliferation of smart homes and the consequent rise in smart dishwasher installations are key drivers amplifying the demand for advanced dishwashing products. Moreover, the increased adoption of rinsing aids by foodservice outlets is a pivotal factor propelling market growth.
However, skin allergies and infections arising from counterfeit dishwashing products may impede dishwashing products market growth.
Regional Insights:
Asia Pacific Registers the Major Market Share Owing to Increasing Awareness in Kitchen Hygiene
Asia Pacific region secures a majority market share. Rising awareness for kitchen hygiene in India and Southeast Asia propels the market's expansion in the Asia Pacific region.
North America exhibits growth with higher consumer demand for eco-friendly household cleaning products, particularly in the U.S. and Canada.
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Competitive Landscape:
Key Industry Participants Focus on Increasing Manufacturing Capacities to Boost their Product Portfolio
Major players are increasing manufacturing capacities for dishwashing and laundry detergents to address consumer demand and facilitate robust sales initiatives. Colgate Palmolive Co. and other industry leaders are embracing environmentally conscious practices, exemplified by products such as the Palmolive Ultra dish soap bottle crafted from 100% post-consumer recycled plastic. This contributes significantly to reducing plastic waste in U.S. and Canadian landfills.
Key Industry Development:
January 2022- Unilever Plc. collaborated with Evonik Industries AG, a German specialty chemicals company, leveraging the partner's rhamnolipids for the production of hand dishwashing liquid for home care applications.
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My 3.5 year pup (chihuahua, dachshund, terrier mix) has dryness and loss of fur around her mouth. She is eating and drinking and playing normally.
She had skin allergies similarly on her paws previously. The vet said it’s allergies and gave anti inflammation and antibiotics (to treat the cracked dry skin which got infected) healed it up. Had an older post on this.
Now her mouth corners area look like dry, swollen/wrinkly and has fur loss again. Anyone have ideas on what it could be? I do not want to keep giving her anti inflammatory meds or antibiotics without a root cause.
Pics below: https://imgur.com/a/CeI2zmz
She wouldn’t let me look at her lower lip mouth area.

The vet said they normally do it at the same time as they neuter, so it’s less painful for the dog, but we are either waiting to neuter or not neutering at all. If it’s extremely painful, we certainly will wait until he is put under. But of course, I want to have the protection of the chip, just in case he gets lost somehow. Or stolen, since that apparently happens to French bulldogs, although I’m not sure how helpful the chip would be in that case.
Also, the vet has said that my dog has great breathing, but he is starting to snore more and waking himself up. I can tell he is struggling sometimes. We have insurance so it should be paid for if he needs any surgery, but the vet hasn’t mentioned anything. I plan to book an appointment soon to discuss it.
Any bulldog specialist recommendations between Detroit, MI, and Toronto, ON would be greatly appreciated. I don’t think our regular vet has a ton of experience with the breed.
Thanks in advance!

Feline herpes or something else?
I’m not sure what to do. 3 months ago I took my indoor cat to the vet for you annual where she was completely fine and healthy. 3-4 days later she started getting these dots on her nose and the sniffles/runny nose. A couple weeks later the runny eyes. So bad that she has hair loss where her eyes run. She has to breath out of her mouth because her nose is so stuff up. Also she started developing lumps on her ears with hairless there as well. She’s not really coughing or wheezing but she frequently sneezes.
About 3 weeks later I took her into the vet and told me it was feline herpes and prescribed her lysine. The lysine didn’t change anything and once I finished that I started her on oral nose relief drops for cats, also allergy immune boost oral oil. I told my vet that she wasn’t getting any better but I didn’t want to take her in because of how much that stresses her out and it’s not going to help her recovery. Not to mention, it’s expensive as fuck for them not to do anything that will actually help. Anyways the vet told me to give her a low dose of Zyrtec. I tried that for a while and she seemed to be doing better for a week or two but now I see it getting worse again.
I don’t know what to do or how to help her. She’s miserable and I can feel her fever is back! There is no change in her food except now she doesn’t want to eat so I started giving her wet food, same formula. We moved but that was back in October, to my moms. I thought my mom’s dogs may have triggered it so I moved in with my bf. She was doing better at first but now it’s all back. She’s been in a nice big peaceful house with us so I’m not sure what is causing this, there are also no other animals or plants in the house. I’ve had her for 3 years now and she is 4. She has never had ANY of these symptoms before march. Is this even feline herpes? Do flare ups last 3 months?? Please any advice would be great. My poor baby is miserable.

Feline herpes or something else?
I’m not sure what to do. 3 months ago I took my indoor cat to the vet for you annual where she was completely fine and healthy. 3-4 days later she started getting these dots on her nose and the sniffles/runny nose. A couple weeks later the runny eyes. So bad that she has hair loss where her eyes run. She has to breath out of her mouth because her nose is so stuff up. Also she started developing hard lumps on her ears with hairloss there as well. She’s not really coughing or wheezing but she frequently sneezes.
About 3 weeks later I took her into the vet and told me it was feline herpes and prescribed her lysine. The lysine didn’t change anything and once I finished that I started her on oral nose relief drops for cats, also allergy immune boost oral oil. I told my vet that she wasn’t getting any better but I didn’t want to take her in because of how much that stresses her out and it’s not going to help her recovery. Not to mention, it’s expensive as fuck for them not to do anything that will actually help. Anyways the vet told me to give her a low dose of Zyrtec. I tried that for a while and she seemed to be doing better for a week or two but now I see it getting worse again.
I don’t know what to do or how to help her. She’s miserable and I can feel her fever is back! There is no change in her food except now she doesn’t want to eat so I started giving her wet food, same formula. We moved but that was back in October, to my moms. I thought my mom’s dogs may have triggered it so I moved in with my bf. She was doing better at first but now it’s all back. She’s been in a nice big peaceful house with us so I’m not sure what is causing this, there are also no other animals or plants in the house. I’ve had her for 3 years now and she is 4. She has never had ANY of these symptoms before march. Is this even feline herpes? Do flare ups last 3 months?? Please any advice would be great. My poor baby is miserable.

First of all I have an appointment with my PCP next week and getting a dermatology appointment is literally a 6 month wait so I'm just trying to get to the bottom of this.
Female, 24yo, Caucasian thyroid condition as well as some minor underlying issues which are unlikely to be a cause /have an effect.
I've only ever been allergic to penicillin but for the past 5 days I've been on and off with a rash mainly on my wrists. It started as skin colored / slightly red raised bumps (almost like a zit starting to form) and also slight swelling which could ofc have been due to my scratching.
It all started about 1 month ago when our dryer broke and we had to wash and dry our clothes in a public laundromat for 1 (!!!) wash only. The day after I was super itchy in my work clothes but all over my body and I suspected that either someone that used the laundry machine before us used a chemical I'm allergic to or washed something e.g. with fiberglass.
However since then I've occasionally gotten itchy on parts of my legs (calves), single points on my scalp, around my nose and - mainly - my wrists.
It's really odd because nowhere else seems to be a rash forming but the one on one of my hands has been, slowly but progressively, getting worse. I'm taking 5-10mg cetrizine atm and it has helped quite a bit with the itching however the past 2 days it seems like it's coming back around late at night and I'm just at a loss.
The raised bumps stay for about 24-48h after the itching has subsided, some have stayed all these days. On my right hand it has been slowly progressing past my wrist and I've been worried it's hives however my husband has experience with this and assured me it's a simple and very mild rash. He also denied it looking like scabies.
I get that it's likely an environmental thing like a newly developed allergie to pollen as the amounts here are moderate however I'm not sure if and when to be concerned. It all seems very disconnected and not related to specific clothes or anything that would touch my body, new soaps etc etc.
I'm also 90% sure it's not shingles as I've unfortunately had them before due to stress and that looked and felt different and wouldn't be all over my body.
When the rash starts flaring up it hurts a tiny bit (about 1-2/10) but subsides quickly.
Would just like to know what's a likely cause here bc every time I try to look up my kind of rash I only get pictures and cases of either clear scabies, hives, horrible horrible rashes etc. - nothing that looks like mine!
Basically I just want to know if I need to see urgent care tomorrow or can leave it be, even if it's slowly progressing up one of my arms, until my appointment next week.
Thanks in advance.

I'm kind of at my wits end and need to get some answers. I have recurring bronchitis and ear infections. I have been to an ENT, who basically dismissed me since I wasn't having symptoms at the time, and an allergist who just confirmed I have allergies. But I am on my 3rd round of serious infections in less than two years. Anyone know a really good ENT and Pulmonologist in the city so I can maybe not have my symptoms dismissed?
Sorry for the rant post, but I'm just frustrated.
Thanks in advance!