The only option I have right now is to see an NP endo (not an MD) and I've had such bad luck so far. She keeps shit talking her other diabetic patients knowing I'm a medical student and trying to bond or something. Consistently shaming other people for any basal rates over 2 or using over 150 units per day. She said at our last appointment that she's sick of people not taking care of themselves or listening to what she has to say and proceeds to say: "but you're obviously not like that, you actually care about your health". I try so hard to squeeze around those conversations and get back to my PERSONAL MANAGEMENT PLAN but it's so hard sometimes. I've seen her 2 times and have started metformin for some resistance issues, but I dread going back because of these types of conversations. Anyone else have experience with this?
I've seen a slew of NP endos because all the MDs in my town aren't accepting new patients (what a surprise) and it's never been great, but this one is something different.

Demographics: Male, Asian, Public School
Intended Major(s): Biology
ACT/SAT/SAT II: 1570
UW/W GPA and Rank: 3.6, no rank
Coursework: 8 APS/3 DE/2 Honors (All 5s)
Awards:

• 1st in HOSA States (1/40) -> sent to internationals
  
• 2nd in HOSA internationals (2/150), (2/1800 overall)
  
• AP Scholar w/ Distinction
  
• National Merit Semifinalist
  
• Honor Roll
  
• NHS
  
• School Award for 5s on both AP Econ Tests
  

Extracurriculars:
Biotechnology and Research Sequencing at the University of Michigan (501c3 research organization) - Explored Nucleotide Hybridization, and led group research linking it to a real-world disease. Analyzed related Thermodynamics, PCR, Advanced Linux, and mapping genomes. Presented a business plan on Biotechnology and Next Generation Sequencing Technology (showing how genetic variation could lead to disease).
11th and 12th grade, 12hrs/wk, 4wk/yr
Medical Student Shadowing and Cardiac Medicine Exploration at the University of Brown Alpert Medical School - Completed a Medical Interview, a Cardiopulmonary Physical Exam with a patient, reviewed different medical careers, learned about the pathophysiology of the heart, and completed an ethics course on heart transplants.
11th and 12th grade, 10hrs/wk, 4wk/yr
Shadowed Primary Care Physician - Pediatrician has experience for 20+ years and ranked the #1 Care Physician out of 45 in my city. Worked in the Biomedical Lab analyzing samples and results for patients (in real-time). I shadowed the actual checkups as well
11th and 12th grade, 10hrs/wk, 3wk/yr
HOSA (Health Occupations Students of America) Competitor (all 50 states + 11 countries competed) (2yrs) - State Champion (1st out of 40 teams) in my 1st year, Only three teams are sent to ILC from Michigan, Qualified for ILC (International Leadership Conference), and placed Top 3 at ILC. Posted on 10+ nationwide news sites, as well as covered by the media. 260,000 members nationwide.
11th and 12th grade, 10hrs/wk, 30wk/yr
Co-Founder of Biomed Club (Only Student-Made Medical Club @ School) (4yrs) - Led in-school Biomedical-Based Medical Club focused on healthcare careers, connecting with licensed doctors and current medical students to inspire youth and teach them about the experience through the medical process. Expanded membership from 4 to 150 in 4 years by organizing talks for younger classmen about life as a doctor.
9th, 10th, 11th, 12th grade, 8hrs/wk, 35wk/yr
Joined SAT/Tutoring Help - Helps students increase their chances for college applications, as well as earn significant amounts of scholarship money. Was able to empower high school students through hackathons, college seminars, and a Cranbrook HUB Program which helped struggling students increase their SAT scores.
10th, 11th, 12th grade, 6hrs/wk, 10wk/yr
Swim Instructor (paid) - Worked for ~1 year, over 400 hours of work, about 8-10 hours weekly on school weeks, and closer to 15 hours during summer, CPR and Lifeguard Certified. Had several classes, weekly, with kids with disabilities, such as Down Syndrome, Autism, and ADHD.
11th, 12th grade, 8-10hrs/wk, 40wk/yr
Swim Instructor Summer Volunteer connected w/Hospital's Children’s Care Center (most vulnerable kids) - Instructed and taught children who have been impaired with neurological, social, and developmental challenges, as well as kids that have dealt with major trauma at a very young age to swim. Participated in a 3-week long program teaching them the basics of swimming.
11th, 12th grade, 8-10hrs/wk, 4wk/yr
Michigan Ref Certified - Participated in overall 50+ hours of ref-related activities, played soccer for 13 years and competed in competitive/travel soccer for 10 years.
9th, 10th, 11th, 12th grade, 2hrs/wk, 13wk/yr (for reffing)
9th, 10th grade, 8hrs/wk, 50wk/yr (for soccer)
VolunteeTutor Work - Volunteer Monthly at an Indian Cultural Program (10hrs/month), Math Tutor for struggling students (3hrs/week), Volunteer Monthly for Key Club (3hrs/month)
Essays/LORs/Other:
APES (7/10)
STEM Teacher (9/10)
Schools (in state for MSU/UMich):
MSU
UMich (EA)
Rice
JHU
BU
Brown
Cornell
Columbia (ED + Legacy)

Calling all ICU, ED, and hospice nurses! Interested in sharing your end of life patient experiences for an upcoming book? I am looking for nurses to interview about their insights, challenges, and triumphs surrounding patient care with death and dying. Please follow the link to schedule <3

getting to work with teens is so fun bc who else would i be able to say, "and if you try to not show up and see me again next week, you better believe i'm gonna ugly cry soooooo loud you can hear me from upstairs and i will NOT stop until you say hi!" to and have it like... work? 💀
like my teen client tonight has locked herself in her bedroom all week refusing to speak to anyone, but she talked to me today after initially refusing. not only that but she started opening up about things her mom said she won't talk to anyone about.i had a supervisor once call me "the teen whisperer" and i don't know how i do it, but it's so rewarding.
on a semi-related note, tonight showed me just how much trauma-informed care is not the standard in helping professions. and how misunderstood trauma is. and how valuable a consistent, patient, committed therapeutic relationship truly is, especially when it comes to people living with trauma.
yesterday i felt like an imposter and today i'm feeling on top of the world. i wouldn't trade this career for anything <3

I want to get a gift set for my orthopedic surgeon I’ve been under his care since 2021 and have finally completed all my surgeries and he was one of the first three doctors who actually listened to me and took me seriously after 14 years of pain and issues with my hips after a car crash, I was always told I’m too young to have hip pain or it was my EDS causing it when I knew it wasn’t. He’s from Singapore but he’s interested in Jamaican culture and cuisine as my parents are Jamaican with some Chinese ancestry so we’ve talked about some similarities.
I was thinking some Jamaican blue mountain coffee as I assume with his job he’s very familiar with caffeine, some cufflinks with the Caduceus symbol or something related to medicine and orthopaedics but I’ve seen some that are made with mother of pearl and you can get the initials engraved and have a message printed on the tin they come in. I was thinking a neck tie but I don’t ever recall seeing him wear any neck ties as he’s usually in scrubs but even when he’s in a suit or a smart shirt he never wears a tie so I’m not sure if it’s personal choice or if he ever wears them. There’s a world food centre near me where I usually get my spices and peppers and little snacks so I’m gonna get them from there but I’m not sure what else would be appropriate but he’s mentioned that he feels happy when he sees a photo of a patient doing things they once loved but were unable to do so I’m thinking a little thank you card with a picture of me doing a split, riding a bicycle, or swimming now I can actually walk properly again
Thank you for any help 🫶🏽

Words can’t express the gratitude and how life changing to have my $140k loan forgiven. I was on the Save plan w Aidadvantage since last August and was in shock that they held true to their word and forgave my loan 5/5. My grandmother was my legal guardian as a child on a small fixed income helped me get Pell grants and apply for scholarships at my HBCU In the late 1990s. I excelled and graduated with honors with only 10k debt from undergrad which I paid off when I finished professional school Early 2000s. However my remaining debt from professional school was over $167k which increased w interest over 20 years. I tried paying it down but was difficult bc self employed and live in a poor state where I can’t work for a corporation w my profession and limited to be self employed. I’m a healthcare provider and worked very hard even moonlight at prisons as independent contractor to support my family. This student loan debt limited our housing options and type of schools our kids can attend. My spouse and I have no help from our parents and to have our debt forgiven which is the biggest financial gift anyone has ever given me. I’m forever grateful for the Save plan And can now continue to afford to practice in a poor rural town and serve patients that have limited access to care. This is one less debt that I can eliminate so can focus on helping others.

Sorry in advance, this may be long.
I’ll start by saying, I’m 24f cw-289 sw-355 Genetics done me so dirty everyone related is morbidly obese, they don’t care. T2D, heart failure, HBP, multiple illnesses due to diabetes and not caring. I want to break the cycle and be healthy. I’m tired of seeing others kill themselves slowly and I don’t want to be the same way.
I started my journey last April. Started intermittent fasting while counting calories- that lead to OMAD. I was very successful with OMAD not so much just counting calories. I have PCOS so getting the weight off has been hard, however, this process has helped me overcome the terrible habits I was raised with and I now have a heathy relationship with food. I lost the 60+ pounds in the last year and have been able to keep it off.
During the holidays, I fell off my one meal a day and went back to counting calories at the beginning of the year. One meal a day just wasn’t doing it for my office job and boredom eating. I have only lost pretty much what I gained back (12pounds) since January. I have battled back and forth between going forward with bariatric surgery for years now. Since I turned 18 really. Both of my parents as well as some aunts and uncles have had bypass and lost the weight and within 3-5 years gained it right back. They didn’t build the healthy habits needed to eat for a smaller body and this lifestyle change, they just thought it was the easy way out.
When I have mentioned interest before I always get thrown in my face don’t waste the money you’ll gain it back like they did or I did. So I get discouraged and chicken out. Now I feel like I have built the boundaries needed to maintain this new lifestyle change. Not necessarily what’s needed but I don’t consume myself with food anymore, I can manage my eating and food doesn’t control my life anymore.
Now that I’ve given you a Huge back story you’re probably annoyed from reading, I have my first appointment to talk with the bariatric team and I’m trying to research as much as possible.
I am pre-diabetic, have pcos, no gallbladder(idk if that matters). I’m bouncing between VSG and bypass. I know bypass is a more invasive or so I’ve heard but a lot of vsg patients get revision so I’m leaning towards just getting Roux-en-y and skipping the hassle down the road.
What are you opinions? Which did you get or wish you would have? How was the journey mentally for you?
*bonus if you have federal BCBS and can tell me how long your process was to get approved, how much you paid out of pocket. I’ve heard they are really easy to work with and get approved. My PCP has been tracking my efforts for over a year now and I know that was a requirement for insurance.

Im living in Ohio. In December of last year I was leaving work and got Tboned in the parking lot. Guy that hit me was driving on the opposite side of where you normally drive, and didnt stop at the white yield paint in the lane tonthe right of me, so was in my blind spot. Hit my rear passenger fender as I drove infront of him. It wasn't a hard accident. It dented the fender but not bad. I hit my head on my driver window.
Driver admitted fault right there, gave me his insurance information and declined to take mine. Not sure if that was a bad idea or not. But at the time I didn't care. My car I spent 1200 bucks on, and it wasn't something brand new or expensive. I just bought it from a family member. So we went our separate ways. I had a slight headache all day after that turned into a migraine. Went to bed with it. Woke up the next morning still having a migraine and went to work. All day long I felt "off".. not sure how to describe it but just felt different. Didn't think anything of it. But as the day went by I got worse. Eventually I tried going on a walk to reset a fire alarm at rhe opposite end of the plant. From here all my memory is foggy. I remmeber walking. Sitting in a stair case for a while cause I got dizzy and my legs were weak. I have brief memories of walking back to the security office where I work, leajing on the wall to support myself. Coworker made me go to the on-site nurse. I've got vague memories of being in her car later as she took me to the hospital and from then on its all foggy. I spent 3 days in the hospital where they believe I had a type of seizure, like subdermal or something. And possibly had a stroke from a TBI. But all my tests and scans came back negative so nothing was ever confirmed.
After I got home I filed a claim with the guys insurance. As i was told by the hospital that due to possibly having a stroke I can't drive for 6 months, and since my work is contracted with GM Motors that meant I couldn't work until I'm cleared. It took several days for them to get ahold of him since he was working so much, and he didn't even argue according to their claim adjuster, he admitted fault right then and there. So the adjuster said they would start the process for a settlement. I figured I got lucky since they accepted liability and didn't do anything else
It's been almost 6 months and last I heard was they're still putting everything together to come up with an estimate. I'm getting final notice bills from the hospital and other medical related companies and ive no clue what to do. Should I have even talked to a lawyer first? Or is it far too late? I didnt even consider it cause I don't know much about this type of stuff and was afraid if I got a lawyer it could go bad for me. Like maybe his insurance company would somehow decide I was actually at fault. Since it was in a parking lot from what I've read I had a 50/50 chance od being found at fault, so when they accepted liability I thought it was best not to push it. Now I'm thinking that was stupid. But its been almost 6 months. I've barely been able to cover bills. I've lost out on a complete social life, dating life, concerts/events. Should I still maybe see a lawyer?

In December of last year I was leaving work and got Tboned in the parking lot. Guy that hit me was driving on the opposite side of where you normally drive, and didnt stop at the white yield paint. Hit my rear passenger fender as I drove infront of him. It wasn't a hard accident. It dented the fender but not bad. I hit my head on my driver window.
Driver admitted fault right there, gave me his insurance information and declined to take mine. Not sure if that was a bad idea or not. But at the time I didn't care. My car I spent 1200 bucks on, and it wasn't something brand new or expensive. I just bought it from a family member. So we went our separate ways. I had a slight headache all day after that turned into a migraine. Went to bed with it. Woke up the next morning still having a migraine and went to work. All day long I felt "off".. not sure how to describe it but just felt different. Didn't think anything of it. But as the day went by I got worse. Eventually I tried going on a walk to reset a fire alarm at rhe opposite end of the plant. From here all my memory is foggy. I remmeber walking. Sitting in a stair case for a while cause I got dizzy and my legs were weak. I have brief memories of walking back to the security office where I work, leajing on the wall to support myself. Coworker made me go to the on-site nurse. I've got vague memories of being in her car later as she took me to the hospital and from then on its all foggy. I spent 3 days in the hospital where they believe I had a type of seizure, like subdermal or something. And possibly had a stroke from a TBI. But all my tests and scans came back negative so nothing was ever confirmed.
After I got home I filed a claim with the guys insurance. As i was told by the hospital that due to possibly having a stroke I can't drive for 6 months, and since my work is contracted with GM Motors that meant I couldn't work until I'm cleared. It took several days for them to get ahold of him since he was working so much, and he didn't even argue according to their claim adjuster, he admitted fault right then and there. So the adjuster said they would start the process for a settlement. I figured I got lucky since they accepted liability and didn't do anything else
It's been almost 6 months and last I heard was they're still putting everything together to come up with an estimate. I'm getting final notice bills from the hospital and other medical related companies and ive no clue what to do. Should I have even talked to a lawyer first? Or is it far too late? I didnt even consider it cause I don't know much about this type of stuff and was afraid if I got a lawyer it could go bad for me. Like maybe his insurance company would somehow decide I was actually at fault. Since it was in a parking lot from what I've read I had a 50/50 chance od being found at fault, so when they accepted liability I thought it was best not to push it. But its been almost 6 months. I've barely been able to cover bills. I've lost out on a complete social life, dating life, concerts/events. Should I still maybe see a lawyer?

Chapter 1
“Ms. Burner am I boring you”. Lacy was awakened by her Teacher spouting off in her usual rant on how people never seem to pay attention in her class. “No Mrs. Hansen, I just dozed off.” Lacy hadn't remembered falling asleep. She tended to do that a lot. She would enter her mind and drift off into a space where she didn't have any thoughts, just an empty spot in her head. That was how she would fall asleep so easily. Her friends and family thought she was narcoleptic and that she needed medication, but Lacy knew that it was just something she had always been able to do. Time seemed to tick on and on in that soul sucking classroom as Mrs. Hansen droned on and on about some subject that Lacy would never need. She felt the sleep creeping in on her but fought it as another strike would end her up in the principal's office and another speech from her father on how she needed to focus in class if she ever wanted to make something of herself. Just as Lacy was about to fall asleep the bell rang making her jump. Lacy was the first to get up before she was stopped. “Lacy, can we talk for a second?” Lacy hated Mrs. Hanse's voice. It always sounded like she felt like she was more important than everyone else. “Lacy, I noticed that you haven't been completing the optional assignments I give yall, and the assignments you need to do you do the bare minimum. It's your senior year, you need to start taking your school work more seriously if you want to get into a good college.” Lacy had already heard this speech before and this probably wouldn't be the last time that she heard it. “I was just really tired today, Mrs. Hansen. I promise it won't happen again.” Lacy turned to walk away from her teacher. She used to get in trouble for doing that but lately it seems that her teachers have gotten used to it. Lacy hated interaction, if she could find a way to not talk to someone she would look for it. It wasn't hard for Lacy to be alone. It's not like she liked being alone, she just didn't mind it. Lacy left the classroom, the only thing on her mind was what she was gonna do this weekend. She usually just sits in her room and listens to music, but recently she started going to the park and would watch the ducks and people. She liked the park because it made her feel like things were going on outside of her life. “Hey Lace wait up” The voice was Collin, a guy who was very obviously interested in Lacy. He would call her Lace which annoyed her but she decided it was better to ignore him than start a conversation she didn't want to have. Lacy wasn't interested in Collin but she liked having someone around. “Do you wanna go to the overpass? Some other people are having a party there.” Lacy wouldn't usually go to things like this but this time she felt something pushing her to go to this party. “Sure, I just need to go home and change first”.
Chapter 2
Lacy walked through the front door of her house to a tv turned up too loud and her father passed out in front of it. From an outside view on Lacy you would look at her and assume that her family life was lacking, but Lacy’s father took care of her and loved her more than life itself. Lacy viewed her father as the best person on the face of the earth. After the loss of her mother, Lacy’s father took up a second job which caused him to sleep more. Lacy didn't mind, she just wanted her father happy. Lacy changed into a black dress and black leather boots and left to go to the underpass. While she was leaving her father awoke. “Lacy I didn't know that you were home.” Lacy's father was a burly man with a beard. The kind of person you want walking with you at night but in reality he was a gentle giant. He worked at a local hardware store and at night he would work as a gas station attendant. He was a hard working man that made Lacy feel as if she could be doing more. “Yeah dad I was just about to head to a party with some friends. I'll be back around nine.” Lacy wanted to stay in with her dad and watch movies but she knew that her father would have wanted her to socialize with other people her age. “You be careful, I can't lose you too.” The sentence came out of nowhere and Lacy didn't know how to respond before her father fell back to sleep. Lacy left the house questioning herself if she should stay or go. Lacy decided that her father would rather her go than stay and pity him. As Lacy was walking away from the porch she noticed a van parked across the street. She chose to ignore it and continue on to the overpass. Along the way she noticed that the van was following her. Lacy became worried and pulled out her phone to call her father. Suddenly Lacy was struck on the side of her head. “Grab her legs. The Shepard is gonna love this find. We gotta get this girl in the hole right away.”
Lacy drifted in and out of consciousness. The last thing she saw was a hole that had a dark aura around it.
Chapter 3
Lacy awoke to a dark hallway. She didn’t notice the building but could hear a crunching sound coming from an indescribable location. Lacy stood up and began walking forward not knowing where she was going. The Hallway felt like it had been going on forever. “Lacy” The voice sounded deep and demonic. Lacy thought that she was hearing things. “Lacy” footsteps echoed throughout the hallway, seeming to come closer and closer. “Lacy” A face peaked out of the hallway. Illuminated by the dimming lights of the hallway. The face was jagged, its eyes were sunken in and unnaturally open to the point where it looked like it was in pain. Its hair was tattered as if it had single strands poking out of its skin and its complexion was a ghoulish grey. The most notable feature was a smile that stretched its entire face. “Lacy” The creature looked at Lacy and stepped out of the shadows revealing a long lengthy body. Its arms were long and slender as if it had not eaten in a long time. Its legs were lengthy making it above seven feet tall. It had only a pair of underwear on and Lacy could see its ribs that looked as if they were trying to break out of its skin. The creature began running towards Lacy, smiling and eyes widening as if seeing Lacy was the best thing it had ever seen. Its teeth were normal except for the blood tint they had. Its neck looked crooked and longer than any human Lacy had ever seen. Without hesitation Lacy turned and ran down the hallway not looking back but could hear the creature getting closer and closer. She could almost feel its hands getting closer to her neck, fearing what the creature would do to her if it caught her. She noticed a door on her left which she could have sworn was not there before. She knew that if she tried to get to open the door now the creature would catch her. Lacy kept running counting the amount of lights she passes to make sure she remembers the location of the door. “Lacy” The creature kept saying her name as if it knew who she was. Lacy couldn't think about that now she had to focus on finding a way to lose the creature. Lacy was running out of energy and decided she had to make a desperate move. She dropped her body and turned around dodging under the beast's arms as it reached for her. The beast ended up having too much momentum causing it to stumble. Lacy took the opportunity to burst into a sprint counting the lights until she reached the door. The creature was still behind her but she had made some distance from making it stumble. She opened the door and closed it behind her. Disturbingly the creature tried to open the door as lacy locked it. It made no noise but continued calling her name. Lacy’s emotions caught up with her and she sat down and cried at her situation. Lacy allowed herself to feel hopeless for only a moment. She remembered her fathers words to her, “I can't lose you too”. Repeating these words in her head allowed Lacy to regain composure. She studied her surroundings realizing that she appeared to be in an apartment. The place was decrepit and looked as if it was abandoned. The furniture was ripped apart and spread among the apartment. It looked like someone had destroyed everything in a fit of passion. Lacy walked through a door which led to the main room. In the room was a tape recorder on a bed. Lacy picked it up and pressed play.
If you are hearing this then you have found yourself in a predicament that could not have been foreseen. I feel for you for I have found myself in the same situation. My name is Professor Crawford. I have yet to understand what this place is exactly all I know is that the being that chased me into this room is still out there. I can hear it against the door. It continues to say my name as if it is trying to coerce me out. I have never seen this being in my existence. It should have no recollection of who I am but yet it continues to say my name. This room has no other exits that I can find. I have no choice but to confront the being outside. May god have mercy on my soul.
Lacy looked around the apartment, checking every corner of the space not finding anything. She entered the kitchen and found a kitchen block that had a single kitchen knife in it. Lacy felt a force telling her to take the knife. She brushed it off and continued looking around. Abruptly the creature began beating on the door saying Lacy’s name. Just as the creature began banging on the door the tape recorder began playing again.
I do not know what this thing is. But it has one feature that can not be ignored. Thus I have dubbed this creature.
The Smiling Man
Chapter 4
Lacy ran for the knife that had tried to coerce her into grabbing it before. Just as the smiling man had broken down the door she grabbed the knife. The smiling man looked at lacy. Its head is covered in blood due to it slamming it into the door. “What are you? What do you want?” The man said nothing and continued walking towards Lacy. “LACY” As it was walking towards her Lacy held the knife in her hand. Determined to live she walked towards it holding the knife out towards the man hoping to scare it off. Suddenly the man burst towards her, its eyes widening and its mouth opening into a horrible smile. Lacy plunged the knife towards it, hitting it in the chest when it stuck its teeth into Lacy’s shoulder. Lacy’s adrenaline was too high to feel the pain so she pulled the knife out and pushed away from the man. She rushed out of the room hearing it running after her. She continued running hearing the creature say her name until she found a corner. Realizing what was happening she used the new found corridors to her advantage. The long hallway was turning into a maze of corridors. She managed to lose the creature but could still hear it saying her name. Mapping the maze out she maneuvered around the man. Sneaking up behind him she pulled the knife up and plunged it down into the man's shoulder. The man didn't make a noise instead peeling over in what seemed like pain. Lacy took the knife out and a sudden burst of rage stabbed the man again. Lacy continued stabbing the man over and over until it stopped moving. Lacy slumped against the wall, knife in hand, covered in blood and terrified of what she just did. She peered to her left and saw a hole. The hole was floating and had an aura around it. Lacy noticed the hole as the one the men put her into before she woke up in the hallway. Lacy contemplated if she should go into the hole. She had nowhere else to go so she stepped into the hole.

DISCLAIMER : I forgot to add it to the title but this post is about HRT in Transpeople taking Estradiol and other feminizing medication.
Hello people im fairly new to everything HRT and will start soon myself! Feel free to note any mistakes i may have made :)
So i have been reading A LOT about a good amount of topics that include factors that influence the Breast Development and there are quite as much confusing and contradicting information, which is obviously frustrating, not only to me, but to a lot of People!
The one thing that was clear, was the lack of information, in studies aswell as in posts in this or other subreddits. We cant influence the studies, make them faster or even have the necessary rescources to conduct our own, but we can definitly influence the amount of information given to each other!
Many posts asking about feminization in HRT, especially in combination with Progesteron, often lack crucial infromation to the specific situations. We dont have any studies supporting which factors exactly contribute to the different mechanisms, but having a good amount of Factors for every Person posting here could give us all a bigger picture and maybe help with every single ones situation, even tho its anecdotally it may still help!
Noones memory is perfect, every bit of Information can help!!!
Also note that all of the following information is what i found, tried to understand and put into context or explain the importance. Im not a doctor and CANNOT give medical advice. Im just trying to theorize about this topic and maybe be able to filter out what can help!

1. Antiandrogen usage (and possible dangers?)

Specifically Spironolactone, an Antiandronegen, is suspected to decrease Breast Size (to be exacty : happiness with breast size). https://pubmed.ncbi.nlm.nih.gov/23055547/
Finding exact reasons for that is extremely difficult and while researching i didnt find ANY other study supporting this claim, even tho beeing reposted here and in other subs over and over again.
The Level of contradiction only rises in prospect of the apparent enlargment of breasts in female patients using Spironolactone.
"Breast enlargement and tenderness may occur in 26% of women at high doses"
is stated on the Wikipedia article on Spironolactone ( https://en.wikipedia.org/wiki/Spironolactone ) and an article is linked as source ( https://www.eurekaselect.com/article/128779 ) that i sadly couldnt access.
As seen in Spironolactone, its extremely unclear what exactly contributes to breast development. Contradicting or unfounded claims seem to rule over general discussion about this topic, but from what i found, Spironolactone does not decrease breast size.
Even though it is agreed upon that lowering Testosterone is crucial for feminization (like breast development), i could not find any rescources to where the Testosterone levels should go. There doesnt even seem to be a general understanding how testosterone exactly influences breast development, the general consensus seemingly beeing that testosterone levels should be low with no exact point where to go, though it is advised to reach the "normal" female level of "testosterone 30 – 100 ng/dl; E2 <200 pg/ml" as stated in "The Practical Guidelines for Transgender Hormone Treatment" https://www.bumc.bu.edu/endo/clinics/transgender-medicine/guidelines/
For many Lowering Testosterone by Estradiol Monotherapy seems to work better and decreases intake of different medications, which is generally preferably, not only in hrt. In order to supress testosterone with exclusively with estradiol, estradiol levels starting form around 200pg/mL are needed.
"studies in cisgender men and transfeminine people have found that estradiol levels of around 200 pg/mL (734 pmol/L) suppress testosterone levels by about 90% on average (to ~50 ng/dL [1.7 nmol/L]), while estradiol levels of around 500 pg/mL (1,840 pmol/L) suppress testosterone levels by about 95% on average (to ~20–30 ng/dL [0.7–1.0 nmol/L])" https://transfemscience.org/articles/transfem-intro/ (Under Gonadal Suppresion)
Current Studies, while limited, suggest there is a higher risk of myocardial infarction (MI), ischemic stroke (IS) and Venous thromboembolism (VTE) ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907681/ ). A thing i have noticed while reading through this is the lack of differentiation in HRT when it comes to Estradiol monotherapy in direct comparison to the use of Estradiol and an Anti-Androgen (AA), aswell as the way the Estradiol entered the System.
Newer research suggest a increased risked of both MI and VTE in prostate Cancer patients taking AAs ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473503/ ). Similarly AAs are suspected to increase risk of IS ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675721/ ). There is also another Study that looked at Adverse effects of gender affirming hormonal therapy, in which 22 transfem people were assessed. Only 5 People did not use any kind of Antiandrogen, 3 of which it appeared to have quite mild Adverse Drug Reactions (ADR), with patients recovering from those effects again. The 2 remaining People were both 45 and actively Smoking, one smoking 30 cigarettes a day and dealing with alcoholism, the other one also smoking and having untreated high blood pressure ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9796635/ ).
Obviously more studies are needed but a possible connection between the HRT risks and antiandrogens, with little to no contribution from estradiol is intriguing and could promote a shift to more promotion of montherapy as a safer way to transition.

1. Progesterone

When it comes to Progesterone i have seen mostly People that said it helped them immensly and People that said it stunted their Breast Development.
Alot of Studies suggest that early intake of Progesterone could potentially negatively influence ultimate breast size in female people that also need to take Estrogen because of Development Issues. Generally its advised to wait for 1 - 2 Years of Estrogen Treatment. https://transfemscience.org/articles/progestogens-early-exposure-breast-dev/
No proper evidence supports or dismisses a positive effect of Progesterone, aswell as timing and amount incase of usage.

1. GH / IGH-1

Insulinlike Growth Factor 1 or IGH-1 play a big role in childhood growth, aswell as in breast development and peak in Puberty. This lead not only me to question if an increase in growth hormone (GH) could help development of proper female body parts.
Aswell as with most stuff, when it comes to studies supporting or dismissing a potential help of GH, there are none i could find.
Because too much GH can have huge negative effects on the body, you shouldnt use any strong GH enhancers.
Naturally human Growth Hormone (hGH) increases through excercise ( https://pubmed.ncbi.nlm.nih.gov/12797841/ )
Also a variety of differen Aminoacids is supposed to increase hGH levels. These include :

l-carnitine : sadly the longterm effects are unknown ( https://jissn.biomedcentral.com/articles/10.1186/s12970-020-00377-2 )
creatine : can increase hGH after workout ( https://pubmed.ncbi.nlm.nih.gov/25804393/ )

I wouldnt use l-arginine, purely because there is good chance for it to have detremental effects on aging and especially in combination with HRT its hard to tell how the body would react. An increased risk is the potential reward not worth in my Opinion ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851093/ ).
These CAN be helpfull but HAVE NOT BEEN PROVEN TO HELP. Im just trying to share what im finding, please do not throw out all your money for supplements that could may aswell have no effect.
hGH could also be increased by other Factors like decrease of bodyfat ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690428/ ) and generally a more healthy life style (which is adviced in any case ;) )

1. Body-fat-(re)distribution
   
2. Different Methods of Estradiol intake
   

IF ANY OF MY INFO IS WRONG, I FORGOT SOMETHING OR I MISREAD SOMETHING PLEASE SHARE YOUR CRITIQUE. IM NEW TO THIS AND IM DOING MY BEST BUT DONT WANT TO SPREAD MISINFORMATION!!! EVERYTHING IN THIS POST IS NO MEDICAL ADVICE AND ONLY EXPLORING THE TOPIC
This post is not entirely finished yet and i will complete it in the next few days. Sharing your own Experience, specifically with remarks to how Estradiol is beeing taken (intramuscular, oral, transdermal, etc), aswell if Anti-Androgens (and which) are used and if Progesterone (which and time in transition when first beginning treatment with Progesterone) is used. Also weight loss and fat distribution info, aswell as breast development time and state are as important! I totally get that this is all private info and everyone feels comfortable to share other things, to feel free to just share as much as you personally want. Also looking at the rulebook : All the stuff im hoping people would share are not for any survey or study, only for exchange of anecdotal sharing of person Experience. As long as one person maybe finds help or even just solice in your comment, it goes a long way :)

Guess I’m looking for opinions and some sort of closure from them, but here it goes.
Some background, my father got kidney failure pretty quickly and was disabled from it. So, he couldn’t do much work wise but still took care of the house. I (about to be 20 this year) was around 13-14 years old and my younger brothers, 11 and 12 when it started. He would go to dialysis three times a week, help take care of groceries, bills, and of course my siblings and I. It was rough but things were good, we were all okay.
My family had to move to another state for my mom’s job, and to be closer to family when my dad does die. Sadly, many people on dialysis don’t live super long, so we went for it and moved a bit before the end of my junior year in high school.
So new state, new school, and of course, a lot of new people. My dad was the same as usual, and my mom busy as usual with work.
Sadly, my dad then passed away from a stroke that put him brain dead, and was only ‘alive’ with being on life support. Traumatizing to say the least seeing his body twitch a lot in the hospital, tubes connected to his body, and no response at all. My mom stayed by his side the whole time, and doctors continuing to tell us ‘I’m sorry’ as my dad couldn’t be saved. So my mom signed papers to take him off life support and let him die naturally. His official death was three days after the stroke.
We had my dad’s side of the family come over to see him, much anger towards them, but that’s a whole other thing. One of my aunts helped with getting my dads urn and have him cremated. Then my mom decided to look through his phone to see pictures of him and see the videos of when my parents and I went to see a band together as my graduation gift. And she was grossed out a bit to see his dick pics and thought he was being his little perverted self. Of course when I heard her say that, I went upstairs as I had no intention to look at that.
Then my younger brother came up stairs to tell me and my other brother that my dad had been cheating on my mom for years and my mom found out through his messaging apps and the amount of photos and videos he had from his meet ups.
To say my mom was heart broken is an understatement. She was livid, depressed, and confused as to why he would do that to her, as he would constantly show and tell her and others how much he loved my mom and how she is the love of his life. Many things were connecting and some of his behaviors were weird from time to time and started to make some sort of sense to all of us.
Now currently, I still live with my mom and help a lot with taking care of my brothers, they’re now gonna be 18 and 19 now, but still have a lot to learn as I am the only one to know how to drive, besides my mom. I work full time as I decided to stop college and save money for myself and my girlfriend to be able to live by ourselves and be able to afford other things like my own car.
My mom is constantly out for work, some times with her friends or her date, out working out, eating out, and buying quite a bit of things for herself. And I’m stuck with taking care of the house, help clean, drive my siblings to their appointments, school events, and have to constantly cook food or buy it for me and my siblings to eat.
I love my mom and care for her, but sometimes it’s hard to not dislike her a lot of the time. She believes that I’m ungrateful, I’m a hypocrite, and now I can’t be open with my depression and how I am suicidal at times to her. She makes a whole big deal and gets upset about it too. I wish she was a mom to me and my siblings instead of a woman who only brings money for the bills and little bit of groceries for us to use.
Not the best feeling when I can’t have some sort of emotional support from her. Also sucks when she would complain with how my brothers and I don’t hangout with her when she has never much asked and doesn’t really show interest in us.
So that’s really it here, any advice for this kinda thing would be appreciated. And thanks for reading, I’ll answer any questions you all have

Careful if you're in P1, walking on Rybná 13-ish.
https://maps.app.goo.gl/u2Q8uVtoiroQKgTP9
Just walked by, with my dog, and someone trued to dump fluids on us from a balcony. It missed, but I still got some splash. I didn't try to look for them, I didn't want to give them the satisfaction of getting a response, but I'm sure they will try again.
So, if by some miracle your out and i'm the area AND you read this, then hopefully you can avoid this spot.

Hey all, physio here (Canada)
What do you guys think: Exercise or no exercise for Bells Palsy in early stage?
The facial palsy uk website seems absolutely excellent and they recommend no exercises for the first three months strictly (even if patient progresses from flaccid paralysis to paresis stage early) Just massage and taping + stretches for unaffected side. Plus education on eye care, speech/eating etc., relaxation and mindfulness.
However I found an NHS leaflet that recommends starting exercises as early as possible, yet this leaflet also links to facial palsy org uk for further info…. Which of course doesn’t advocate for starting early.
Searching other resources also gives conflicting advice
any opinions, research or experience with Bells or other facial palsies? What would you recommend?

Foot Doctors Serving Manhasset, Huntington, Coram, Woodbury, Mineola, Williston Park & Maspeth, Plainview NY Advanced Podiatry is the largest and highest-rated Podiatric Medicine and surgery group on Long Island and Queens. As you navigate through our site you will find a wealth of information about podiatry, foot care, foot, and ankle ailments, new treatments available, new modalities, exercising, and shoes. As licensed and Board Certified Podiatrists on Long Island, NY we believe our patients deserve to have the information needed to make the right choices about their foot and ankle care. We treat bunions, sports injuries, toenail fungus, ingrown toenails, and heel pain. For more info visit - https://www.lifootcare.com

Oregon’s Respiratory Virus Data

Test Positivity:

• Data for week ending 05/11/2024, updated as of 05/15/2024 (and prior week revised):
• Positive tests: 37 (64)
• Total tests: 1,523 (1,863)
• Test positivity: 2.4% (3.4%)

🚩 Positivity rates down slightly from last week.

Covid-19 Variants in Oregon:

• Most prevalent: JN.1
• Samples sequenced week of 03/24/2024

🚩 JN.1 has been the primary variant detected since early February 2024. No new sequencing reported in last week.

Hospital Capacity:

• There are 117 Total Covid-19 patients hospitalized on 05/14/2024 (Prior week: 131).
  
• "Total Covid-19 patients" include any patient who has either suspected Covid-19 or a positive Covid-19 test.
  

Total Cumulative Covid-19 related deaths:

• As of 05/15/2024: 10,357 (Prior week: 10,353)

🚩 4 deaths reported for w/e 03/17/2024 through 04/28/2024

Vaccination Effort Metrics:

• Metrics current as of 05/01/2024.
• 79.8% (3,402,946) have initiated Covid-19 vaccination and have received at least one dose of any Covid-19 vaccine.
• 74.1% (3,160,387) have completed their primary series (1 J&J, 2 Moderna, or 2 Pfizer)
• 19.5% (834,206) have received the Fall 2023 vaccine. (Compared to 24.1% by this time last year)
• Counties with the highest rates of vaccination: Hood River, Multnomah, Washington, Benton, Lincoln
• Counties with the lowest rates of vaccination: Lake, Malheur, Grant, Gilliam, Harney
• As of Nov. 2, 2023, OHA has slightly changed the metrics being reported.

Long Term Care Facilities Vaccination Data (OHA):

• Report as of 04/01/2024, Last updated 05/08/2024.
• Number of LTCF reporting: 512
• Percent of staff up-to-date: 12%
• Percent of residents up-to-date: 25%
• Covid-19 vaccination data are reported to OHA on a monthly basis by Oregon assisted living, nursing, and residential care facilities. Data includes summary counts of staff and residents who are up to date with their vaccines. 'Up to date' is currently defined as having received the 2023-2024 vaccine.

Wastewater Monitoring

• Positive on most recent sample: 84%
• Negative on most recent sample: 16%
• Updated 05/15/2024

Hi everyone!
I've been working on a school list for the last few months (stress), and I'd love to hear any feedback! I'm focusing on applying to schools that focus on underserved areas and patient care, thank you!
About me:

• CA resident, Asian female, low SES, no ties to any other states
• BS in Pharmaceutical Sciences
• GPA: 3.8, MCAT 508

Hours:

• Clinical paid employment (MA): 3187
  • Underserved population - PCP office: 2187
  • Urgent care: 1000 + 1344 prospective
• Non-clinical paid employment: 211
• Clinical volunteering: 60
  • Hospice: 20 + 114 prospective
  • Free clinic: 40
• Non-clinical volunteering: 938
  • Refuge outreach organization: 884
  • Elderly support phone calls: 54
• Leadership: 690
• Tutoring: 558
• Research: 481
  • No pubs/presentations
• Shadowing: 72 (2 primary care, 1 pulmonology)

School List (no particular order):

1. UCI (CA)
2. Kaiser (CA)
3. UC Davis (CA)
4. UCLA (CA)
5. UCR (CA)
6. UCSD (CA)
7. UCSF (CA)
8. USC (CA)
9. Drexel (PA)
10. Rush (IL)
11. Loyola - Stritch (IL)
12. Northwestern (IL)
13. University of Chicago - Pritzker (IL)
14. Georgetown (DC)
15. George Washington (DC)
16. Mayo Clinic (MN)
17. Tufts (MA)
18. Vermont (VT)
19. Frank H. Netter - Quinnipiac University (CT)

Do you think my school list is okay, and are there any schools I should add/remove? Thank you again for all your help, and good luck to everyone with this cycle!!

Foot Doctors Serving Manhasset, Huntington, Coram, Woodbury, Mineola, Williston Park & Maspeth, Plainview NY Advanced Podiatry is the largest and highest-rated Podiatric Medicine and surgery group on Long Island and Queens. As you navigate through our site you will find a wealth of information about podiatry, foot care, foot, and ankle ailments, new treatments available, new modalities, exercising, and shoes. As licensed and Board Certified Podiatrists on Long Island, NY we believe our patients deserve to have the information needed to make the right choices about their foot and ankle care. We treat bunions, sports injuries, toenail fungus, ingrown toenails, and heel pain. For more info visit - https://www.lifootcare.com

Hello everyone!
I've been playing with amp sims for a few years, mostly using Neural DSP's Nolly, and I've built a good set of "multi-use" presets for playing and recording songs.
A few months ago, I started playing with a band again and bought a Pod Go a couple of weeks ago. At home, I play with a pair of FRFR monitors, and in our first rehearsal with the Pod Go, I used the Return input of a Randall amp we have at the rehearsal space (we rent it by hours, so the amp isn’t mine). The thing is, even though I tweaked all the parameters carefully, including disabling the cab block of the preset, the overall sound I got was far from the "real" sound of the Randall. I don't intend to imitate its sound exactly, but at least it should sound more real. The Pod sounded very digital and dark until I adjusted the EQ, which improved it quite a bit, but it still felt very digital.
Next week, we have another rehearsal, and I've decided to try running directly through the PA, using the powered monitors the singer currently uses. This way, both the guitar and vocals would come through those speakers.
If I do it this way, I'll need to reactivate the cab block on the Pod, so I have to dive back into the world of impulses.
Can anyone recommend a good impulse for playing rock that pairs well with a Marshall? We’re covering bands like Foo Fighters, Green Day, Ramones, Black Sabbath, The Strokes, etc.
What I'm looking for is someone to say, "Hey, dude, for that type of sound, I use this specific impulse with this specific amp on the Pod, and I love how it sounds," rather than something like "Have you tried Ownhammer impulses?" :D. I say this because I need specific help, not just a recommendation for an impulse manufacturer. During hourly rehearsals, we don’t have much time to try things out :D.
I also have a question: The other day, while trying out the Wah, I realized that I can't activate or deactivate it with the expression pedal itself, as I would with a real wah. Is that the case? Meaning, if I need to use the wah, do I first have to step on a switch to use a preset or snapshot that has the wah and then move my foot to the expression pedal? Isn't there a shorter way?
Thanks!

A recent chat with a newly qualified mid 20's ANP where they explained that they did nurse training with a view to then go directly onto an ANP course which would enable them "to work like a doctor" got me thinking about their training.
Picking a course at random (Southampton University) I did some reading.
https://www.southampton.ac.uk/courses/modules/hlth6219#learning
They state that this course "will qualify you to independently assess, diagnose, treat and manage the care of people with complex clinical problems".
It can be studied over 2 to 5 years with no dissertation required for PGDip.
Here are the following modules:
Diagnostic assessment and decision making. 5 hours tutorial and 45 hours teaching.
History taking and physical assessment. 27 hours of classes and workshops.
Transition to ANP. 24 hours lectures and 18 hours tutorial.
Pharmacology and prescribing in clinical practice. 57 hours teaching.
The total teaching over 2 years divided over a typical 30 week university year comes out at around 3 hours teaching a WEEK.
So a 3 year nursing degree followed by the above to independently manage complex patients is deemed safe and appropriate?
When a doctor is required to undergo 4-6 years of medical school followed by 5 years post graduate training to CCT as a GP to be in the same position.
Again, we have been let down by the Royal Colleges. Who at the RCGP thought that this level of training would be acceptable to allow nurses to see undifferentiated patients and compete for jobs with doctors?

Are these assessments? I put “could not assess” for temperature in my charting. My mgr said CNAs could not do any assessments and to write “Could not get.” She also said I could not describe urine color in my charting. I’m wondering is describing urine and bowel movement color and consistency, size etc an assessment? Can I describe how a patients moves, steady vs unsteady? Or is that an assessment? I’m acute care. Mention it bc I know in icu/crit care some nurses like to chart almost everything.