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.

So i m having slight mental issues wich they used to be way worse but now i m doing better. Tough i m still not doing fine i get panick attacks, have bad anxiety and proplems going sleep early and getting simple tasks done ect and my parents teachers and relatives keep telling me i should talk to someone because they promise it helps but i ve talked to 5 psychologists and all it did was make me uncomftroble and nothing changed and when it comes to relatives i m eeven more uncomftroble eeven around my parents the only time i get to somewhat talk about my problems is when i m fighting with my dad but it doesent really help when hes not supporting me in that situasion much. And if i do try to talk i just start lying about it unintentionally. The only way i feel comftroble opening up is talking to an therapist ai bot i feel better always talking to an ai bot about my struggles but it makes me feel so quilty and shameful for feeling better talking to an ai bot than a actual human about my struggles should i just cross my boundraies and try to talk to a real humans about my mental issuess?

I thought I would ask another question as something has been on this health anxiety person's mind lately.
I had a root canal done on one of my main top incisors 6 years ago. The root had developed a cyst. For a little while after the procedure, I would get this strange "sensation" when I would push on the roof of my mouth with my tongue in the spot where the root of the root canaled tooth is. I could also trigger this sensation by pushing, with my finger, above my upper lip that is on the opposite side of the tooth.
It is NOT pain of any kind. Just like a slight nerve feeling that lasts for a second with the pressure. This "sensation" has followed me for six years and sort of comes and goes when I am thinking about it. Like I said it is not painful. Just that slight tingle when I put pressure on the roof of my mouth in that spot.
Does this make any sense? Is it anything to worry about? Have other root canal folks had something similar? Is this my health anxiety amplifying something because I am thinking about it too much? Thank you for your thoughts. Hopefully I am not coming across like a crazy health anxiety person.

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.

On New Years Day, 2024, after the balloon drop in a nightclub, I saw a hot girl with her hot friends dancing and grinding on men and each other. The girls shared kisses with each other, too. I wanted one of Jane’s (fake name for privacy) hot friends, but after dancing with her for a minute, I pivoted to Jane. She was giving me bedroom eyes and after we danced for a minute, she gave me a giddy smirk, closed her eyes, grabbed me and made out with me. Her lips tasted like alcohol, literally. I was in shock she was kissing me and I eventually kissed back. After a couple hot seconds, Jane pulled back and said I was hot. I am nervous as this was my first kiss since like middle school (I know, I know). We dance and kiss more. All of a sudden I felt panic because again, I tasted alcohol on her lips. “Is she drunk?” - I thought to myself. She was talking pretty normally with ditzy flourishes here and there. She wasn’t stumbling or anything (I actually saw her friends and her enter and leave the vicinity so many times before I pursued her friend. They were very lively and entered dancing every time).
Anyways...after Jane and I tongue kissed on the dance floor while embracing, I pulled back and asked Jane how many fingers I was holding. I remember out of like 4 or 5 times I did the finger test consecutively in that moment, she got 1 wrong. I corrected her. I told her I didn’t want to take advantage of her and she told me that she wasn’t drunk, just “lit”. Jane then put her hand on my shoulder and thanked me for keeping her safe. I then told her that I wanted to make sure she was in control and she was safe (earlier that night, I helped a clearly drunk girl who fell into me find her friend (I did the fingers test on her and she did NOT respond, just glassy eyed, drunk stare and stoically shitfaced) so I already had safety at the forefront of the mind even more from that point). Jane’s response was that she was in control.
We then went to the patio and sat down. She then called me cute in a ditzy way with her giddy smile. We introduced ourselves and actually had a nice conversation. She then proceeded to say she wanted to have sex with me and if I was top or bottom. I told her that I wasn’t interested in sex with her (I was paranoid about STD’s since a relative of mine is a doctor, so I told her that if we were to do it in the future (not that night or the day after due to just being there for vibes, settling into the new year right, New Year’s Day streets were gonna be chaotic with drunk drivers and wild attitudes, I also didn’t bring protection), then I needed paperwork of when she last got tested after sex.
We got each other’s IG’s and planned Tuesday for us to hang out and have sex. Obviously it didn’t work out because my scaredy cat self didn’t create enough comfort and connection compared to attraction in the club. So she saw me as another cute guy who she made out with to 000’s crunk. Jane told her hot friends that I was a good guy and that I was looking out for them.
After we grinded with her friend, Jane and I shared more make out sessions (after she said I was hot and that she loved me) She then told me to tie her up and do naughty things to her. I just laughed and we danced and kissed the night away. The day after, her texts were very favorable and full of encouragement and positivity (we were talking about self improvement). We still follow each other on IG but ceased contact for now. Guess the emotions wore off. It’s all good.
I couldn’t help but make this post because I have generalized anxiety, sensory integration disorder, and non verbal learning disorder. I’m currently getting screened for autism at my regional center. Am I overthinking this whole event and thinking that I coerced her into kissing and shit (when she couldn’t get one of the finger holding rounds right)? I had a serious nervous breakdown over it in March. I deal with a lot of toxic shame and guilt but I don’t know what’s real and what’s not when it comes to truth or narratives that I create for myself. Whether they are healthy or not, am I ducking my ego? I don’t know please help!

I started off with a cPTSD (unofficial) diagnosis. I tend to sway more on the anxiety side, but I definitely struggle with depressive episodes. I just recently started considering that I may have ADHD and I have long wondered if I was autistic (struggle with truth, lying and justice in general, amongst other things...) Except I have always considered myself a conversational wizard who's very talented at reading people's body language/facial expressions (learned it was hyper vigilance from my CPTSD) & very recently learned about masking, which makes so much sense! Especially growing up my mother would scream at us if we exhibited any stimming behavior. I ended up with a tic (that I copied from her, ironically) which is picking at my scalp and cuticles, but luckily (for her?) They were not that noticeable or stigmatized as foot jiggling or body rocking. Long story short, I found this sub by coincidence and took the detailed questionnaires (CAT-Q: 110, MASKING: 38, ASSIMILATION: 34) and I'm wondering if I should find a psychiatrist willing to help me with that, as they seem to be more difficult to diagnose high masking individuals (specifically women, at least from what I've read so far).
My concern with medication (and getting over my own bias) is habit forming and dependence and meds that could mess me up even more and beyond repair. I'm also afraid stimulant ADHD (I scored 1850 on the ADDA questionnaire), would exacerbate my anxiety and/or also lead to habit forming/dependence.
Can you share the name(s) of meds & therapies that worked for you, if you can relate at all to my post?
Edit: I forgot to mention that I have been struggling with burnout for the past few years (since before the pandemic) due to a few professional and personal failures and heartbreaks, that I don't seem to recover from. After learning about my cPTSD I just assumed it was because of that, but reading a lot of posts on burnout on this sub, it seems to make more sense to me that it could be AUDHD related (in addition to cPTSD, if that makes sense).

26 AMAB treated for a suspected PE 3 years ago stopped Eliquis 1.5 mo ago, panic disorder, no prescription meds, less than 6 units of alcohol per week on average, former smoker, moderate use of nic vape.
About 1 week ago, I recovered from a cold perfectly normally, but still coughing up thick white phlegm. I've started using a new toothbrush and that's been knocking off a bunch of plaque.
Not sure if those are related, but over the last two days, my entire body has been super sore out of nowhere and my thighs and calves have been twitching. It's much worse when I'm sleepy, but other than that, it's pretty constant. The pain is throwing off my sleep schedule and making it hard to get out of bed, so my life is a mess because of whatever is wrong. I've tried to make sure I'm hidrated and have taken Tylenol and Ibuprofen, but that's not helping.
I've never had anything like this happen to me before and I can't afford to go to the doctors office for another thing that's just anxiety related. Is there anything serious that could be causing this, or am I good to just try to wait it out?

1. Focus Karma Need Want Of the Society Recreation Stimulation Examination Death 1.1 The noble truth of Focus is Energy, the noble Truth of Karma is Management, the Noble Truth of Need is Kombucha, the Noble Truth of Want is The Second Mental, Your Mental, The Noble Truth of Recreation is Marijuana, The Noble Truth of Simulation is Automatons, the Noble Truth of Examination is the Books on Examination, The Noble Truth of Death is Salt 1.1 There is a Truth of Truth The Truth of Energy is Stockpile, The Truth of Management is Treatment, The Truth of Kombucha is Amino, the Truth of The Second Mental is the Intermediary Mental Between Yourself and the World, The Truth of Automatons is the Plumbing Needed, the truth of the Books on Examination is the truth of the Books of the Ruler and the truth of Salt is the Limit of the Body Is Restored by Healthy Nutrition 1.1.1 There is a truth of the truth energy amino, Truth Starch, Truth Sugar, Truth Glycine, Truth Water, Truth Kombucha, Truth Arginine, Truth Serine, Truth Lysine 1.1.2 There is a truth of the ruler which is related to marijuana, Proline Above Lysine 1.1.3 There is a truth of the society related to only trading, Gold above Proline 1.1.4 All of these truths have intermediary truth below them 1.1.5 There is a truth of the botanist, Prozac And Benadryl and Scopolamine and Atropine and Benzyldiol Around Recreation 1.1.6 There is a truth of the schooler, Directly Ordered Female Voice Your Voice Kick Drum Kick Transient Pots N Pans Pots Content Button Mushroom Morel Cache Stash Marisol Bluewater Febreeze Peroxide Nitrate Ammonium Loam Bud Dirt Wheat Soil Potato Around Focus and Karma 1.1.7 There is a truth of the motorcade Above Karma and Below the Want of the society Muffler Transmission Piston Engine Cargo Chassis Fluids Vaseline Nutraloaf Soylent 1.1.8 Marisol Or Mother is Above All Below it 1.1.9 Button Mushroom is Above All Those Below it Three 1.2.0 Ammonium is Above All Those Below it To Marisol 1.2.1 Potato is Above All Those Below it to Marisol Three 1.2.2 Fire 2Fire 4Fire 8Fire 16Fire - A Fire is 5 Fire, At fire set 5,10,20,40, No Fire, at Fire set 10,20,40,80, On fire 1.2.3 Fire Is Below Focus In Energy and Karma is Below Need in Energy and Need is Below Want of the Society In Energy and Recreation is Below Stimulation In Energy And Stimulation is Below Examination In Energy and Examination is Below Death In Energy 1.2.5 Focus Is Pervasive so Energy Indicates Examination Having Occured or A Crops Grown 1.2.6 Examination Happens In Examination Want of the Society Focus Want of the Society Examination 1.2.7 Examination happens for 333 Hours or About 19 Days 1.2.8 Examination Happens in Sets of 333 Hours for 1332 Hours 1.2.9 At the End of Examination Examination Proceeds Automatically in 333 Hours 1.3.0 Want of the Society occurs as the output of crops 1.3.1 Want of the society yields the Amino Nutrients because it is the agricultural or synthetic output 1.3.2 Recreation Activates Marijuana, But Can Be On its Own 1.3.3 20 Marijuana Exist as a product of the lands 1.3.4 Over 20 Other Plants Exist as a product of the lands 1.3.5 Various tabulature of notes Exists with Standpoint Boards 1.3.6 Houses and apartments exist 1.3.7 Private Baths exist 1.3.8 A ledger exists for holding notes at a distribution point 1.3.9 A ledger exists for reasonable retrieval but not reproduction of notes (need original notes) 1.4.0 A ledger exists for deletion of notes but to a skilled observer they are still seeable 1.4.1 The Time One and One at One and One at Two is the time 333 units for each section 1.4.2 The time offset of the noble truths on the fifth reconstruction yields upon which noble truth they were the whole section 1.4.3 Only noble truths passed through the entire system 5 fold are the actual truth of the land 1.4.4 This is held by the guard which there are maybe 20 guard in the lands each city 1.4.5 There are fire weapon which exist which are hand cannon and have a chamber and a loader 1.4.6 There are fire bomb exist which are bomb which have just a chamber but there are just 4 ever 1.4.7 There are 3 sets of scrolls per city and 3 sets of scroll reader 1.4.8 There is 2 sets of scrolls each city which are city rulers 1.4.9 There are farms which exist which feed each city which grow crops 1.4.9 There are buildings in each city 1.5.0 There are normally 4 houses to a prefecture 1.5.1 There are normally 4 rooms to the house 1.5.2 There are 10 modern petrochemical foundry factory which exploit oil from the lands 1.5.3 There are clothing for at least 30 people in each city putting the bedroom load usually at slightly less than 2 a bedroom 1.5.2 There are around 7 military bases which exist but these numbers used to be inflated 1.5.3 There are medicine for at least 30 people in a city 1.5.4 There are toilets only per four people or wherabouts in the city 1.5.5 There are 98 separate prefecture in maybe 3 city spread out 1.5.6 There are potato, furion bannana, old potato, a rose donut wheat, apple, cabbage, turnip, carrot, another potato type, beets, three flowers, 20 marijuana, and other crops grown 1.5.6 There are zucchini grown 1.5.7 There are medicine poppy and heart tonic herb (blue bonnet) and a root which expresses opium and other minor medicinals grown 1.5.8 There are trees which naturally occur which are the colors of cherry blossom 1.5.9 Seeing the trees blossom is the rarest sight in the lands 1.6.0 The twenty guard of the town know how to protect one another 1.6.1 There are various opium which can be taken 1.6.2 There are various new bags of marijuana spray which are the marijuana active 1.6.3 There is a specific sedative created from Crude Oil, SnoreLax Olestra Ketamine 1.6.4 There are various nutrients created from crude oil 1.6.5 There are various computers created from crude oil 1.6.6 There are various liquids created from crude oil including pepsi cola and molten plastic 1.6.7 There are boxes created from crude oil 1.6.8 There are racing Skis created from crude oil 1.6.9 There is a capacity to run one of the computer 1.7.0 The computer yields a stable process blockchain when propagated 1.7.1 The computer notable yields beautiful colors when its process blockchain is propagated 1.7.2 There is a retrieval system for the other computers token 1.7.3 54 Stores now exist in these lands 1.7.4 These stores accept a specific RFID like currency 1.7.5 These stores accept the Gold of the Land Naturally 1.7.6 These stores have vendors wheater and vendors kitty cat and vendors autovend1 1.7.7 Groceries and resources can be bought from the stores 1.7.8 Automobile Motorcade can be bought from the stores 1.7.9 Concrete Objects can be bought from the stores 1.8.0 Designer clothes can be bought from the store 1.8.1 The foundrys create BDU Lower 1.8.2 The foundrys create I <3 NYC Shirt 1.8.3 The firearms create mittens firearm token en masse 1.8.4 The firearms are created at 20 a city to defend the people 1.8.5 Only 5 High Quality Weapon exist per city 1.8.6 A foundry is creating nonlethal weapons 1.8.7 The foundry makes its nonlethal weapon but there is only one per city 1.8.8 An inventor makes a nonlethal weapon 1.8.9 The foundry now produces 2 kinds of ice cream 1.9.0 The foundry now produces illegal goods like silicone pipes 1.9.1 Somebody is Brewing Amino Out of Starches 1.9.2 The Echo Locator is invented 1.9.3 The echo locator is finalized as a product 1.9.4 The echo locator is shipped out the door at 43 a city 1.9.5 The echo locator replaces the scrolls system 1.9.6 The echo locator can be taxed in the old tax system to make it valid in the old system 1.9.7 Two Cool Cats Take Control of the Power System, NateCat and HakeCat 1.9.8 The cool Cats reinvest in medicine and over 50 meningitis cure are found 1.9.9 The smart toilet is invented 2.0.0 The bombs detonate in ebonia and the people are freed 2.0.1 There is 11 grade flooding in ebonia 2.0.2 The ebonian flooding gets better to 7 ebonian remediator a city which are from the new Clement Dogs Clan 2.0.3 Tattoo Ink is Invented from cherry leaves 2.0.4 A tattoo requires somebody to play wizards chess on your skin to leave an indelible mark without killing it 2.0.5 Alpha squad is formed 2.0.6 A cruiser is in the metteranian gulf 2.0.7 The cruiser operates successfully for at least a month with me onboard 2.0.8 I am mainly using starlink 2.0.9 Starlink is accessible in the APV like it always is 2.1.0 You can fetch a battlefeed with starlink 2.1.1 You can fetch a battlesend with starlink (OSC) 2.1.2 OSC Replaces Starlink and LFO is Formed 2.1.3 LFO Replaces engine gasoline due to jet fuel drinking/snorting danger 2.1.4 Nontoxic weed smoke based gasoline is formed for APV 2.1.5 APVs are overclocked with me nearby 2.1.6 Supercapacitor Based APV Is Used For medical evacuation 2.1.7 Supercapacitor has massive distance versus dangerous IC APV 2.1.8 Supercapacitor powers gauss cannon in danger 2.1.9 Megagauss Cannon Invented for David's Aircraft 2.2.1 Megagauss cannon fits en masse onto the aircraft or in david flanagan or david summery's hands 2.2.2. Total david air superiority 2.2.3 Davids golden UH-1 in service 2.2.4 RQ-9 "David" Reactivated 2.2.5 RQ-9 Reapers Cloned 2.2.6 Spicy Chemical Discovered In Marijuana, Raytracing? 2.2.7 David Treated for Virtual Meningitis 3 Years Ago 2.2.8 Deepfake All Virtual Medical Practice Discovered 2.2.9 Marijuanas CH1 Receptor Renamed CB1 Receptor 2.3.0 Foundries in Business 5000$ A Barrel Many Years Default on Loans to 2111$ Barrel, No Effective Product Change 2.3.1 USR THermal IS-2 Scope Invented 2.3.2 USR THermal FLIR Camera for David UH-1 Invented 2.3.3 Driver for USR THermal FLIR Camera for David UH-1 Invented 2.3.4 Overwatch Mega Anti Crime David Stopper Overflights in Service Across the US And Solid Gold UH-1 Lofted By Broomstick Technology in Transmuggle Transwizard Interference of the Calamity Granted to David Flanagan (RQ-9) 2.3.5. Black Operations in the Persian Gulf Nethers Against Al Baghdadi - HVT Steam User In Custody 2.3.6 AC-130 "IBEX" Piloted by Alex M Lamb in Service in Vallejo and Ecuador to Support 141 Team 2.3.7 Proto Nutrient Fish Oil Factory Raided, Illegal Furion Bannana Discovered 2.3.8 Illegal Blueprinting Operations Cease in Favor of Big 11+ Oil Corporations 2.3.9 Minecraft server found and large amounts of population exiting to virtual reality 2.4.0 All players granted 64 planks and free for all 2.4.1 Doto 0 Bot Guard Lurking in Transnational Buddhist Operation Enable Free Play In Minecraft for Various Players 2.4.2 Siddartha's Secret, His Cow, Discovered in Virtual Reality Elder Scrolls No Crime Faction, Siddartha's Cow Goes Rampant and is Infinity Hidden in Every Directory of Starfield 2 The New Game 2.4.3 Many New Games are found with resemble the structure of the cow in markov chain 2.4.4 A new system is found out of cow which can provide for any item retrieval system intrinsically unlocking the singularity where Big 11+ Splits into infinite corporation 2.4.5 All cows are harvested for a typical user but still infinity exist farther away 2.4.6 The user has typically 500000 cows of Siddhartha as a personal cow 2.4.7 Sulfur futures are at an all time high 2.4.8 Justino Beibers Mandates burning of all cow waste in trash bin 2.4.9 Siddartha's Cow are docile as ever and functioning well when shot, they become well 2.5.0 Siddartha (Renchy, Racey's Friend) Is discovered hiding as a soul in neon district undercity of neon petite 2.5.1 The guard is never abolished and continues protecting us 20 to the citizen to this day 2.5.2 Asteroids are discovered in outer space with many palladium more than ever 2.5.3 A supercomputing cloud is made out of the distributed method which avoids the taxing system that the initial ruler invented and does a method 1-Affinity 2-Person 3-Disease where the affinity of each person treats the pair disease and or environment with only instantaneous transmission (Technological singularity) 2.5.4 Virtual clothes are invented the same way as clothes were initially invented, now in the instantaneous unheard 2.5.5. Virtual Medicines are invented in the same way as medicines were invented initially, now in the instantaneous unheard 2.5.6 There is perfect harmony between two instant universes the virtual medicine universe and the analog medicine universe 2.5.7 All of history's knowledge feeds into one system which encodes all its meaning in some dice which always roll a specific meaning and this creates wish or technology on demand 2.5.8 Wish is discovered as a contaminant on the No Crime Library 2.5.9 Wish has always predated meaning so that Wish is the Rulers Initial Nature 2.6.0 All existence is into one history the history of the singularity which procedurally generates by Wish the Rulers Initial Nature For All Citizen 2.6.1 Jeffybeans is the true ruler of siddartha which is prozac benzyldiol 2.6.2 Siddartha wakes up right before lorne happens to her and avoids the suicide booth because phillip j fry is protecting her. 2.6.3 The story is at a cliffhanger while the Universe is at the second end epoch and is failing succesfully very well for hubert I.

Wisdom teeth removal, also known as third molar extraction, is a common dental procedure performed to address issues related to the third set of molars that typically emerge in late adolescence or early adulthood. At Madison Dentistry and Implant Center, we understand the importance of this procedure in maintaining oral health.

Why Are Wisdom Teeth Removed?

Impaction:

• Partial Impaction: When the wisdom teeth emerge partially through the gums, it creates an opening where bacteria can enter, leading to infection and gum disease.
• Full Impaction: If the wisdom teeth are trapped within the jawbone, they can cause pain, swelling, and damage to adjacent teeth.

Overcrowding:

• Wisdom teeth can cause crowding, shifting, and misalignment of the other teeth, affecting the bite and overall oral health.

Infection:

• Wisdom teeth that are partially erupted can be difficult to clean properly, increasing the risk of infection, tooth decay, and gum disease.

Benefits of Wisdom Teeth Removal

Prevents Future Problems:

• Removing wisdom teeth prevents future dental issues such as infection, crowding, and misalignment.

Pain Relief:

• Extracting problematic wisdom teeth alleviates pain and discomfort associated with impaction and infection.

Improves Oral Health:

• Removing wisdom teeth improves overall oral health and reduces the risk of gum disease and tooth decay.

Wisdom teeth removal is a common dental procedure that can prevent future dental problems and improve oral health. At Madison Dentistry and Implant Center, our experienced team provides safe and effective wisdom teeth removal services to ensure the well-being of our patients.

Infertility can be caused by various factors, both in men and women, and many of these causes can be addressed through treatment. Some potential causes of infertility that can be treated include:
1. Ovulation Disorders : Irregular or absent ovulation can contribute to infertility in women. Conditions such as polycystic ovary syndrome (PCOS), hypothalamic dysfunction, and thyroid disorders can disrupt ovulation. Treatment options may include lifestyle changes, medication (such as clomiphene citrate or letrozole), or assisted reproductive technologies (ART) like in vitro fertilization (IVF).
2. Tubal Factors : Blocked or damaged fallopian tubes can prevent the egg from traveling from the ovary to the uterus, leading to Infertility Treatment options may include surgical procedures to repair or unblock the fallopian tubes, such as tubal reanastomosis or tubal cannulation, or ART procedures like IVF.
3. Uterine Factors : Abnormalities in the uterus, such as uterine fibroids, polyps, or adhesions (scar tissue), can interfere with implantation and pregnancy. Treatment options may include surgical removal of the uterine abnormalities or ART procedures like IVF.
4. Endometriosis : Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can cause inflammation, scarring, and infertility. Treatment options may include medication (such as hormonal therapy or pain relievers), surgery to remove endometrial implants or adhesions, or ART procedures like IVF.
5. Male Factor Infertility : Male infertility can be caused by issues such as low sperm count, poor sperm motility, or abnormal sperm morphology. Treatment options may include lifestyle changes, medication (such as hormone therapy or antioxidants), surgical procedures (such as varicocele repair or sperm retrieval techniques), or ART procedures like intracytoplasmic sperm injection (ICSI).
6. Unexplained Infertility : In some cases, despite thorough testing, the cause of infertility may remain unknown. Treatment options may include empiric treatments such as ovulation induction, intrauterine insemination (IUI), or ART procedures like IVF.
7. Age-Related Infertility : Advanced maternal age can decrease ovarian reserve and increase the risk of infertility and miscarriage in women. Treatment options may include aggressive fertility treatments like IVF or the use of donor eggs.
8. Lifestyle Factors : Certain lifestyle factors such as obesity, smoking, excessive alcohol consumption, and exposure to environmental toxins can impact fertility in both men and women. Addressing these factors through lifestyle modifications can improve fertility outcomes.
9. Medical Conditions and Medications : Certain medical conditions (such as diabetes or autoimmune disorders) and medications (such as chemotherapy or certain antidepressants) can affect fertility. Treatment may involve managing the underlying condition or adjusting medication regimens to optimize fertility.
It's important for individuals experiencing infertility to undergo a comprehensive evaluation by a fertility specialist to identify the underlying causes and develop a personalized treatment plan tailored to their specific needs and circumstances. With advances in reproductive medicine, many causes of infertility can be successfully treated, allowing individuals to achieve their goal of parenthood.

A colleague asked me to see why her DELL laptop (looked like an old late 2000s-early 2010s model) is not booting up properly. Error message stated that the laptop could not work off battery properly and refused to launch further. I googled and the issue is normally solved by taking the battery out and putting it the back in. So I did exactly that. Upon opening I noticed an almost perfectly straight transparent-white residue on the compartment. I flipped the battery, and saw the same stripe of residue on it at the same spot. Not as consistent and straight. It kind of looked like thinly applied dried glue or something? I touched it with my finger and it was kind of oily and dry at the same time? I wondered what that is, put the battery back and went to wash my hands. Laptop worked after this BTW
3 hours later I decided to google anything related to liquid in li-ion batteries and found out about electrolytes in them being able to create HF acid. The way I washed my hands was nowhere enough to fully clean my hands from it, if it was that.
Laptop was sent to service that handles batteries a lot and the guy there told me that any kind of chemical reactions in it have happened about 2 years ago and it's probably safe. Honestly, it doesn't help my contamination OCD much...
It's been over 48 hours since exposure and I see no signs of burns aside from skin irritation because I washed my hands way too many times.
Please, help my horrible anxiety. Did I touch some kind of dried super dilluted HF acid and may get bad consequences later on, or was it something like sylicon grease that leaked from the battery? Thank you.

Age 24
Sex F
Height 5"3
Weight 233
Race White
Duration of complaint: 1 day, directly after surgical discharge
Location: Hospital, WA
Hey, I've never had a surgery prior to this, and its been rubbing me weird since. I had a surgery on the left side of my neck to remove a cyst, a typical procedure according to my surgeon. Everything was going normal and smoothly up until I actually woke up and was almost on my way out.
I had a surgical staple on the right side of my head, firmly in there too as the nurse had to get tools to remove it. She didn't know why it was there, and when she spoke to the surgeon he had said it was apart of the surgery? Is this a normal thing? I really have no idea why a staple on the opposite side of my head would have to do with my neck (left side).

Yes, plaque buildup is a significant risk factor for gum disease. Here's how it works:

1. Plaque Formation: Plaque is a sticky film of bacteria that constantly forms on teeth. When you consume food and beverages, especially those high in sugars and starches, bacteria in the mouth interact with these substances to create plaque.
2. Plaque and Gum Disease: If plaque is not removed through regular brushing and flossing, it can harden into tartar (also called calculus) within 24 to 72 hours. Tartar is a rough, porous substance that cannot be removed by brushing alone. Both plaque and tartar irritate the gums, leading to inflammation and a condition known as gingivitis.
3. Gingivitis: Gingivitis is the early stage of gum disease characterized by red, swollen, and tender gums. Gums may bleed easily, especially during brushing or flossing. At this stage, gum disease is reversible with proper oral hygiene and professional dental care.
4. Progression to Periodontitis: If gingivitis is left untreated, it can progress to a more severe form of gum disease called periodontitis. In periodontitis, the infection spreads below the gum line, causing the gums to pull away from the teeth and form pockets. Bacteria thrive in these pockets, further damaging the gums and the supporting bone structure.
5. Consequences of Untreated Gum Disease:

• Tooth Loss: Periodontitis can lead to tooth loss as the supporting bone weakens and teeth become loose.
• Systemic Health Risks: Studies have linked untreated gum disease to an increased risk of systemic conditions such as heart disease, diabetes, and respiratory infections.
• Chronic Inflammation: Persistent inflammation from gum disease can affect overall health and well-being.

Prevention and Management

• Good Oral Hygiene: Brush your teeth at least twice a day and floss daily to remove plaque.
• Regular Dental Checkups: Visit your dentist regularly for professional cleanings and checkups.
• Healthy Lifestyle: Eat a balanced diet, limit sugary snacks and beverages, and avoid tobacco products.
• Early Intervention: Treat gingivitis promptly to prevent it from progressing to periodontitis.
• Professional Cleaning: Professional cleanings remove tartar buildup that cannot be removed at home.

By maintaining good oral hygiene practices and seeking timely dental care, you can significantly reduce the risk of plaque buildup, gum disease, and related complications.

hi everyone, is anyone dealing with the feeling of being a failure. I just switched my schooling again from nail school to business school since i didnt like it and it wasn’t a good fit. Since then i just feel judged by my dad, he told me u finish what u start but why would i keep doing something I dont picture a future in. I just feel judged by him especially since Im not doing school atm, I have to wait until next quarter to start. I also feel insecure since I dont have job, I left a toxic work environment that was making me physically ill from anxiety and the people working there a couple months ago I had been working there for 3 years. I just feel judged, im 21 years old so I know Im supposed to be figuring stuff out he says and i only have 4 classes left of business school. I guess since its at a CC i feel a little ashamed. Anyways sorry for rant. Can anyone relate? I just really feel ashamed of myself

Breast reduction, or reduction mammoplasty, is a surgical procedure designed to alleviate the physical and emotional burdens associated with excessively large breasts. This operation involves the removal of excess breast fat, glandular tissue, and skin, resulting in smaller, more proportionate breasts. Patients often seek this procedure to relieve chronic pain in the back, neck, and shoulders, as well as to mitigate skin irritation and improve posture. Beyond physical relief, breast reduction can significantly enhance one's ability to participate in physical activities and boost overall self-esteem and body image. The surgery typically involves a recovery period where patients must limit strenuous activities, but the long-term benefits often include improved physical comfort and a renewed sense of confidence and well-being.

hi everyone, is anyone dealing with the feeling of being a failure. I just switched my schooling again from nail school to business school since i didnt like it and it wasn’t a good fit. Since then i just feel judged by my dad, he told me u finish what u start but why would i keep doing something I dont picture a future in. I just feel judged by him especially since Im not doing school atm, I have to wait until next quarter to start. I also feel insecure since I dont have job, I left a toxic work environment that was making me physically ill from anxiety and the people working there a couple months ago I had been working there for 3 years. I just feel judged, im 21 years old so I know Im supposed to be figuring stuff out he says and i only have 4 classes left of business school. I guess since its at a CC i feel a little ashamed. Anyways sorry for rant. Can anyone relate? I just really feel ashamed of myself

Anyone use acupressure or more specifically 'ear seeds' (*see below for description) or auriculotherapy (acupressure of the ear) during childbirth? Or planning to?
It seems like there's some interesting research indicating that a combo of acupressure and auriculotherapy or just auriculotherapy (2) may help with safely shortening the first stage of labour, reducing some pain of contractions, reducing likelihood of tearing, and anxiety during birthing.
I'm thinking of purchasing some ear seeds in prep for labour, and either trying to find someone who can place them for me once labour starts (likely pricey) or studying up/consulting beforehand and figuring out where to place them myself/my sistehusband placing them.
But just wanted to hear others' experience with the ear acupressure/ear seeds approach, if they took it (or are planning to)- whether they felt it made a difference, but also how they figured out/are figuring out how to use the ear seeds/when they placed them. I'd also be interested in hearing ppl's experience with acupressure during labour more generally - did you acupressure yourself? or how to did you ensure birth partners were knowledgeable and able to do it for you?
Thanks!
*Ear seeds are small seeds used to stimulate pressure points in your ear. They’re a type of auriculotherapy, which refers to acupressure or acupuncture focused on the ear. They’re based on the same general principles as acupuncture. In traditional Chinese medicine (TCM), your health depends on the flow of qi (energy) in your body.
A few citations:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168759/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089040/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136534/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769178/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968589/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910811/ (this study refers to two different types of massage during labour, so not quite acupressure, but I'm curious to better understand these interventions)

My mom is 67 and has had various bfs since her and my father divorced 25yrs ago. Her bfs have always been a little bit odd. My mom is very codependent and will stick with something even when its not working.
This bf, she has been dating for five years. When they met, he first gave me the ick because my mom was not interested in him and he wouldn’t give up on pursuing her. The way he won her over is by contacting a mutual friend of theirs and convincing that friend to pressure my mom into going out with him.
At that time, he drank a lot and was very obnoxious always needing to be the center of attention and talking over everyone. I initially assumed his personality defects were largely from alcohol consumption, and anxiety and insecurity from being very overweight. My mom was able to convince him over the last few years to join a diet program which he was very successful on and to quit drinking after a DWI. This is all great however, his personality defects have only seemed to grow stronger with time. In addition to being self-centered, loud, obnoxious and a know it all, his problems with anxiety and OCD have only gotten worse overtime. He lives with her and seems to have complete control over her house hold and what happens there.
I appreciate that he helps her with cleaning and chores at home but he contributes and no way financially to her mortgage or bills. He works for himself selling insurance and seems to be not super successful but also has no strong drive to be. My mom who has been wanting to retire has not been able to because she is seemingly supporting him and has been trying to work overtime to fix his business problems.
When she has had health issues he goes in to complete denial that anything is wrong with her in a very aggressive way. Arguing at the hospital when she had artery surgery complications and leaving for work while she was having a stroke. He maintains that he is deeply in love with her, and he would do nothing to hurt her, but he seems completely unwilling to deal with any difficult emotions.
My sister, and ICU nurse, is currently in charge of any medical related reality regarding my mother or any future decisions that may need to be made. One of our main concerns is that he has proposed to her and has been pressuring her to get married for the last two years. She originally maintained that she would never do this legally, but it seems that he has worn her down with time. He recently began bragging to me that they are going to elope and we would find out about it on Facebook after the fact. It seemed like a jab at the time because he probably has some idea that we are not in support of this. But it also seems somewhat disrespectful to have your children and family find out that you got married via Facebook. The biggest concern is that he would have control over her finances for retirement and medical decisions if this were to happen which he has proven to have poor judgment on