Testoserone therapy doses

Ive had some really difficult times in the last few years and no matter what antidepressant i took or what kind of therapy i did, nothing worked. My gp decided, as a last resort, to try citalopram. Since i always get very bad side effects i started on 5mg for the first 3 weeks. Im on 10mg now for the past 2 weeks and i can say that i feel 40% better, which i didnt expect. She asked me to start 15mg today (having to cut to pills is not fun), and im a bit scared i might get side effects on this dose(i cant stop yawning for the past hour). The only side effect i had on 10mg was late period. My gp didnt think 10mg would do much of a difference,but i feel it has made. Is it just a placebo effect? Has anyone else had an improvement on such a low dose? I dont know if it matters but im just 5ft

Hi, my surgeon put me on a blood thinner called Rivaroxaban (Xarelto) after my flat foot surgery to prevent blood clots. I'm on hormone replacement therapy for perimenopausal symptoms. Unfortunately, the thinners made me bleed heavily for 10 days instead of the usual light 4 days. After that I took myself off them and started taking low dose aspirin instead. I'm up to the next bleed now and have stopped the low dose aspirin but panic about getting a blood clot. I'm taking garlic, ginger, turmeric, primrose oil and flaxseed oil instead as a preventative. I'm wondering how many other people having foot surgery were put on blood thinners too if they were in a cast? Is this common practice? Thanks.

My partner has suffered from anxiety since before I met him. When we met, he realised it was anxiety (not chronic pain) and he started psychotherapy. It really helped and we got married and quickly got pregnant, as we both wanted.
Come second trimester, and he basically lost it completely. He's not sleeping, he's in pain, he's throwing up constantly.
He's going to therapy twice a week, and started seeing a psychiatrist as well and getting intense medical treatment. I say intense because most people I know get a small dose of SSRIs to start with and it's normally enough to get them stable. He has a bunch of different pills, the psychiatrist keeps upping the dosage and took him off SSRIs.
He's not responding to the pills, although he is occasionally able to sleep.
The thing is, I really need support right now. I'm late in my pregnancy, I'm also hormonal, I want to prepare for labour, for parenting etc.
But he - he's terrified of being his father, who he loved, but died several years ago before they could resolve why he used to take out aggression and anger physically and mentally on his sons.
My husband isnt aggressive or often angry, although lately when I trigger him he is very angry and hurt and says the worst things to me.
He's terrified of being his mother, he still wishes she would parent him instead of looking to him as a replacement partner at best, or parent at worst. He feels the loss of his father through the unmet expectations from his mother.
He's been care-giver to his grandparents before they died, and he tends to feel full responsibility even when it is shared.
He's crumbling, yet he's supportive in a lot of things. He cooks and makes me eat, he's often there to hear my struggles and pains.
But a lot of the time I feel like I need to be the strong one. That he's "got it worse". Which is true, but I have my own hangups about becoming a mother, about labour, about the big life changes.
I'm also lugging around this baby, and every emotion and chemical response in my body is transferred to him. I feel guilty for crying for hurting and for fighting with my partner - when my partner is hurtful and I'm suffering, I wish I could extract the baby from inside me because I don't feel like I'm the safe haven I should be.
I end up going alone to prenatal classes. Sitting between all the couples and having no one to perform the exercises with. And when I tell him how hard it is for me, I'm triggering his anxiety. I'm not allowing him to get better. I'm the worst thing for him right now.
I feel like I'm being really strong, but it isn't good enough. Sometimes I slip up, I talk about subjects he can't deal with, I get upset when he needs space. I've even lost my patience for hearing his pain and felt a lack of sympathy. I feel like I'm supportive 90% of the time.
He feels that I'm demanding, useless and that 100% of the time when he reaches his limit, I don't respect him and I cause him more pain.
Above all this I love him so much, I really believe in him and I KNOW he'll be a fantastic father. I want him better, mostly because it's terrible how much he is suffering, but also selfishly, so that we can focus on me and the baby, being pregnant, preparing for labour and post partem and becoming parents.
His pain is always worse than mine, his feeling are more extreme than the impact my hormones have, his sleep more interrupted than mine. His inability to show up at work affected by mine, so when I WFH and have meetings , they trigger his feelings of inadequacy.
Whenever I'm on the phone with a family member I have to hang up, because he is having a panic attack, or throwing up or just doesn't want to hear my "stupid familys drama".
I know it sounds like I'm bitching, but I just want to hear if anyone else here has gone through what I'm going through.
There is a sub reddit for partner depression, but it's not quite the same as this trauma that's being dug up. He's not depressed, and it's not about becoming or being a parent.
Did anyone else experience this before children? Might it get better? Will it get worse?

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

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

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

1. Evaluator Have you ever had withdrawal symptoms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I was raised by a father who was bipolar type 2, had borderline personality disorder, severe depression with constant suicidal ideation, the most severe anger issues I have ever seen in a human being in my life (imagine if logan roy from succession got hooked on amphetamines, about like that), and he committed suicide when I was 19. I was not allowed to feel in my home, if I was upset about anything at all, then that meant that I was "whining" and needed to shut up and be more grateful, even when I was "whining" that he took so many pills that he forgot me having to stop his suicide attempt, and I got angry when I mention that event and he went "what are you talking about?", I thought he was gaslighting me at first, but I later realized the combo of drugs he was on and his own severe mental instability had actually blocked that memory out from his stupid fucking head, but I was wrong for getting upset because "it's not my fault I don't remember". Not even the point, the point is I was raised that expressing emotions of any kind was a direct affront to my father that would not be taken lightly by him, and I VERY MUCH internalized that. It took me 18 months after his death to be able to shed a single tear about the situation, and even then it was tears of anger, and I had to force myself to cry, it was like my head was a hot air balloon of a whole lifetime of emotions and pain I had locked away and wanted to let it out but I couldn't, then when I did let it out, it hurt so much, that I wanted to numb it all away again, and that's when the drinking got really bad. I am 9 months sober after almost dying from anemia caused by a severe long term gastric bleed caused by my drinking (they consider the life threatening range for your hemoglobin level anything below about 7-8, yea, mine was 3.4 when i got to the hospital, it took 7 bags of blood just to bring me up to barely stable), and it left me with some liver scaring, I was so desperate to not feel all the pain that I drowned it, and now I'm finally having to come up for air, and oh boy. I feel like I have no idea who I am. Where does the me that my parents molded me into end and the me that is my true self begin. Will I ever be able to enjoy my interests without the deep seeded shame I have for stuff like watching anime that I have from my dad quite literally calling me a pussy for liking anime. I got a hunter x hunter charm necklace thing and I've been wearing it and I like it, but I still am so incredibly self conscious about it because of the time I tried to wear a necklace in like 5th grade and my dad said it made me look "faggy", which is absolutely fucking insane because my dad was genuinely not homophobic, my aunt was gay and she was frankly the only one of his siblings he actually liked, he didn't have a bigoted bone in his body, but what he meant is "girls won't go for you if you wear that", but fuck you, I was in 5th grade and (very much due to the emotional repression) I wouldn't get truly interested in dating until, let me check, NOW. I had a long term girlfriend through high school and college who was my first love, but we only started dating because she asked me out, I have never made the first move on a girl a single time in my life, I've quite literally never flirted. My whole life, I have been so scared of relationships because the only one I saw was my parents godless nightmare of a marriage where they were "staying together for me" even when I was in high school ACTIVELY ASKING THEM TO GET DIVORCED, because they were such fucking nightmares. I have always thought that whatever good feelings of love and fulfillment I would get from a relationship would never outweigh the pain that would come along with the fights, and only now that I'm finally starting to break through the layers of repressed emotions and that I've dried out off of the booze am I finally starting to feel different. The thing that is so hard is, I've just pushed all my feelings and all my pain down so deep for my entire life, that now the emotions are all coming at once, and good God I just can't handle it sometimes. I also got diagnosed as bipolar type 2 today, just like dear old dad, still sending gifts up from hell, just in time for my birthday too. The pain, the feeling that I have missed out on so much of my life by being to afraid of getting hurt to allow myself to have anything good. I feel like I've missed out on so much of life because of that bastard, and now I'm 25, I barely recognize myself when I look in the mirror, and I am trying to basically rebuild myself from the ground up after I almost died and got sober, and I am basically by myself dealing with it (very long story, but basically because of his death, our family business went under and my mom and I had to move to her hometown, in with my aunt and uncle, and I have no friends here and I am not close with my family and they are a bunch of judgmental Bible thumpers who basically think I'm a degenerate for drinking and a snowflake for my mental health issues), and I just feel so deeply intensely alone. I was so numbed for my entire life, that I didn't even actually know you could feel emotions this intense, the way that the sorrow just feels like a bottomless hole in your chest, and all I want is to feel like someone cares about me and that I matter. My mom is here with me, and she is doing her best, but if you can't tell from the post, she isn't exactly blameless in the cause of the issue, so that is kind of a double edged sword. I try and keep in touch with my friends from my hometown, but they're busy with their lives and they don't always have the time, plus I always feel like I'm putting them out when I need their help (there's that trauma again). I'm in therapy and I just went up to twice a week, but that still only helps so much. I even want to start dating again, but I'm stuck in a small town in the middle of nowhere in south Alabama, where the dating pool isn't exactly huge, and gets widdled down a LOT more when you take into account that I'm an agnostic democrat. God, every day I ask myself, why isn't he still here, so I can let out all of this pent up emotion and pain onto the person who actually deserves it, but even then I know it wouldn't make me feel better. So as I'm finally starting to be able to even have emotions again, I'm reminded why I wanted to numb them all away. I just feel alone, and like I don't even know who I am, and that who I am might not be the person I wanted to be, and there's a healthy dose of self hatred mixed in, and all I want is for someone to hold me and tell me it will be OK, because I know it will, but God damn it why does it just have to be so damn hard sometimes. Why did he have to die without me ever getting to tell him how he hurt me to his face. How could he rob me of that. He got to die with the last thing I said to him being that I loved him, and I have to take to my grave that the last thing that I ever said to my father was a lie.
Edit: TLDR: Abusive dad caused me to be so emotionally repressed that when he died I became an alcoholic to numb the pain and now that I'm sober and chipping away at the emotional repression, I feel an entire lifetimes worth of emotions hitting me all at once and it is incredibly overwhelming and has left me feeling like I don't know who I am and that I am all alone just picking up the scraps of my life, while not even knowing what the life I'm picking up even looks like. I just wish he was still alive so I could tell him all the things I didn't get a chance too while he was alive. All the awful, hurtful, painful, gut wrenching things I would say to him.

After a few years of Dexamphetamine (dexedrine IR) use (and abuse), I decided to completely quit medication and get clean. My docter stopped my prescription. This was 2 years ago. After a rough first year, I went into therapy and decided to start medication again but this time only the non-stimulant variants. I tried bupropion 150 & 300mg without any positive effects and I also tried strattera 80mg for a while without any effects.
Because my ADHD symptoms negativally effect my motivation and focus for my full-time job my doctor adviced to start Dexamphetamine again but this time the extended release variant, called Elvanse here in the Netherlands, it's the same as Vyvanse. I already picked up my prescription and I'm gonna start monday with 30mg and raise the dose every week with my docter.
My question is, is 30mg dex IR comparable to 30mg's of Elvanse? Because my dosage with the IR variant 2 years ago was around 40 to 50mg per day. If I take the same dose for the elvanse it should be the same effects im guessing considering the fact that both are exactly the same substance.

I started K w/o any coaching or therapy and i didn't know what to do with the experience. It was surrounded by extreme stress pre and post IV infusion (70mg). At least 10 sessions and every one was the same, i was just out there floating and riding on ribbons of color feeling VERY alone. I came away with no insights at all. w/o insights what is there to guide you? I switched to diff provider (far lower cost) but they did intramuscular. I was popping out of the trip in say 15 minutes so they gave me a booster but it did nothing. They were shady and wouldn't even tell me the exact dose they gave me. They said most people don't get any insights at all. I just don't understand what there is to integrate if you come away only remember riding on ribbons of color and feeling lonely. I have C-PTSD from narc abuse in a very long marriage that I can't exit. My anxiety is through the roof, living hell. Due to the stress before/after I had to take a clonipin and i'm wondering if that's what prevented me from the disassociation, prevented insights, and had me popping out of the IM sessions (2 of 10 were IM). any and all thoughts here are welcome as I am at a loss on what to do. I want k-therapy and prep/integration but cannot find a provider to work with and don't know where to find them. I'm in MD. Thanks ahead of time for any help/suggestions/info.

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Hi all,
I used to take adderall for 8 years prior to taking a 1.5 year break from it. My doctor recently prescribed me a step therapy for adderall for my first month back on it. I’ve been taking it every other day. The first day I had anxiety because of my elevated heart rate. the second day no anxiety. Today, the third day I had anxiety due to feeling my heart rate being elevated. I’ve never once had anxiety on adderal in the 8 years that I used to take it unless I didn’t get enough sleep. I haven’t really been sleeping well for the last 3 months and have been super sleep deprived. Is this normal starting off on adderall again after taking a long hiatus? I did increase my dose after the second day from 10mg to 20mg as I felt I didn’t feel any of the mental effects on the 10mg dose, only the physical effects. I know I probably should have stayed on the 10mg for a week but I am beating myself up over taking that second 10mg dose. What could be causing my anxiety all of a sudden since I restarted adderall?

Hi there! I'm kind of new to this and looking for support. I've only been off of testosterone and publicly detransitioning for a month now. I'll write some of the backstory out and then my questions/concerns about my former transition and what to do next. I might ramble, my apologies. I have a lot to say, and I am definitely feeling emotional about it all. It's a big deal.
I'm (27F) woman and I was transitioning as an FTM for over 5 years. I have a bit of a complicated transition history that stretches back into my earlier teen years, but I medically transitioned in my 20s for that 5 years. I only went on testosterone and never got any procedures done. However, I passed fairly well when binding and with my facial/body hair growth. I was diagnosed with gender dysphoria but I'm not sure if that was correct or not. Honestly, I think I struggled more with body dysmorphia than anything gender-specific. I've had a very traumatic life (just saying that for context, I don't try to live my life in a victim mentality, my trauma has just influenced my decisions) and I went through puberty early so I was more aware of sticking out than someone in general would have. I genuinely did feel like I was transgender at parts of my life, but I don't think I would have identified that way if I had received better mental healthcare and guidance for how to accept and love and care for myself as the capable woman I am.
Overall, I think my transition was successful in a way because I accomplished a lot of life goals during the process and connected with myself. I finished undergrad, got into graduate school, worked hard in academia and in jobs, became a professional artist and writer and much more- all things that I never thought I was smart enough to do before transitioning. (I know, that sounds terrible :c ) Ultimately though, transitioning was leading me to an unhealthy place. I started to uncover a lot of traumas in therapy linked to bad male figures in my life and I started to piece together that perhaps I was trying to become the positive male figure that I never had before. Honestly, becoming that "man" did help, but the whole time it was just me. I'll never have a father, and I'll never get the peace and innocence I had before former abusive relationships, but I should have understood that my inner strength was inside of me as a woman the whole time. I didn't have to be a trans man to access that. I never experienced life as a single adult woman since I was always under negative male control, so this new phase of life is an entirely new world to me in a way. It's exciting, fresh, scary, and I am feeling so many things. I don't feel bitter about transitioning but I'm silently highly critical of my past situation and the way I regard other transitions I see IRL and online.
Towards the last two years of medically transitioning I started to experience really weird symptoms. There is a possibility that some of this is tied with long covid because I got seriously ill a couple of years ago, but I noticed symptoms become worse when dosage went higher and better when dosage was lower. Eventually, my doctor put me on what he called a "nonbinary level" which got my levels to somewhere around 99 when he said they should have been at 300. This was the point that I took medicine into MY own hands and told HIM that I wanted to be on that low dose because I felt better on it even though he wanted to increase it for some reason.
The symptoms I was having were heart palpitations, chest pains, muscle aches, loud joint cracking and pains, weakness and prone to injuries, vaginal dryness and pain, dizzy spells, and more probably that I can't think of. I have brought up these things to various doctors especially the last one and none of my "transgender healthcare professionals" seemed worried/interested enough to investigate what was going wrong other than give me blood tests or prescribe me a medicine that I wouldn't take. I felt like I had to handle my own treatment plan by becoming uncomfortably self-aware of my body situation and adjust my weight, supplements, and testosterone based on what would make me feel the least crappy. I felt abandoned by the medical field and I'm having to search for competent clinicians now who can see what's actually happening with my health. Thankfully most of the negative side effects have either subsided or lessened considerably but I don't know how much damage was actually done. I'm very grateful I still have my breasts and that my reproductive system is working a bit better, though I haven't gotten my period back yet.
Another frustration that helped me choose to detransition was understanding that the trans space is actually more dangerous than people want others to see it as. I hate saying that it's dangerous because I don't want to fearmonger ever, it's more of a logical observation. The amount of people that were predatory towards me when I was a trans man is shocking. I have trust issues already and I thought that presenting as male would protect me, but there were several who knew how to manipulate my insecurities and benefit from my vulnerability. A couple of months before I made the choice to detransition, I was a victim of a very violent SA from a "friend." I was hospitalized and injured for weeks if not months and it made me reconsider everything during the intensive therapy. My eyes opened to the reality of "chasers" who just wanted to feminize me, enact their kinks on me, and objectify/brutalize/humiliate me for my inherent womanhood. The people that claimed to love me as a trans man in theory, hated me as a woman in practice. It was horrific.
I'm so so so thankful that other detransitioners are being vocal about their experiences and reaching out even though it's a hard thing to do. I feel like I've been saved from a lifetime of extra pain and challenges that I was tricked into. My experience could have been much worse, and it was already not good.
While now I'm learning how to love myself more and navigate the world and processes of detransitioning, I'm also facing my mindset changing towards transitioning. At this point in time, I do personally believe that some transgender people do exist with gender dysphoria, but I think it is much rarer than the dominating narrative seems to suggest. I've started to hear more about AGPs and one of my friend groups almost all transitioned to become "trans women" but they don't seem to put in any effort to socialize or appear like women. They only tend to have sexual discussions and have started to seem very predatory and creepy towards me and others. One of them is convinced she has a period too. I have distanced myself from them because they have crossed my boundaries and I feel very threatened. But I feel like I can't confront them about the offensive gender issue because they'll think I'm transphobic when in reality, I feel like they're being misogynistic and hurtful.
Has anyone else experienced difficulties in healthcare/bad hormone side effects? Or what are your thoughts on dangers in the trans community? Do you have any tips on how to navigate the early stages of detransitioning? I just filed for my name change and am hoping to get laser removal soon! :)
Thank you so much for reading and any comments/advice. I appreciate it. I'm a little lost and nervous.

For context, I’m 28, non-binary, not on T (but considering micro-dosing), and have been binding for about 7 years. I’m in therapy now and have discussed top surgery with my therapist (along with other issues).
I think I do have dysphoria and my therapist seems to believe so too. But somehow I can’t fully 100% say - yes I was top surgery. I have so much worry about possibly regretting it. I have wide hips and I’m worried about how I’ll look post-surgery, increased hip dysphoria, etc. And then there’s worries about how I’ll be treated by society - doctors, family, potential partners, friends - if I do this.
How do you come to peace with negative external factors?
What made you feel like you were actually ready for top surgery?

Hi All, Our dog has been on compounded Trilostane (70 mg) for about 3 months to get Cushing's Disease under control. She is a spayed lab mix about 78 pounds. We are not sure of her age as we adopted her from the pound. We think she is between 11-13 years old. She had her second checkup today (05/17) to determine how the meds are working. She has been vomiting more than usual the last month or so and gets diarrhea now and then. In fact, her appt. was on Monday but had to be rescheduled as she was sick and threw up her meds. After her test to check her levels after 2 hours, it came back at 1.4 µg/dL. The test result form we received states < 1.8 µg/dL - Consider adjusting therapy. Emergency medical attention may be needed if iatrogenic signs present. I raised my concerns about this value combined with her throwing up and diarrhea. The vet said she wants to keep her on this level of Trilostane since her liver values have improved so much. (The liver values went to the low side of the high value, so it is working to get her liver issues under control.) They ran an additional blood panel and everything looks great. They sent her home with antibiotics and anti-nausea meds. I'm still wondering if the dose of Trilostane is too high since her value is below the recommended value.
Trilostane FDA Label Recommendations The following are used to guide decisions based on the post-ACTH stimulation cortisol values. Cortisol <1.45 µg/dL: Stop treatment. Restart at a decreased dose.
My biggest concern is I don't want her getting Addison's or worse. She's the best dog and I want her golden years to be as good as I can make them for her. I appreciate any insight or experience into why the vet is ignoring the low value, the vomiting/diarrhea and continuing the current dose of Trilostane. Thank you!

Just posting this as an update on my experiences and situation regarding the hormone patch shortages. Bel (TTGC) was incredibly helpful and understanding during the urgent appointment I booked with her yesterday. She gave me a new script for Estradot patches (apparently the reason it wasn't working was because the pharmacist didn't send me a new token). She also set me up with new prescriptions for both gel AND injections and has told me go with whatever I prefer and get a blood test 3-4 months after being on a steady dose.
She also offered me information on care plans, speech therapy, counseling AND local social peer support groups.
I ordered the injections today since I'm more inclined to go with those (my background in nursing and just generally feeling more confidence/peace of mind with an injected medication just makes me like it better). Estradiol Valerate subcutaneous route, 0.2ml injections, cost 150 for a 3 month supply. In the meantime I'll probably have to temporarily use the gel while I wait for the injections to arrive since it can take up to a month to arrive from the compounding chemist.
TTGC is wonderful, Bel is truly a life saver. Also very much thank you again to the user on here who recommended that I go for the urgent appointment, really saved me there.

31F non smoking, not drinking, 130lbs at 28 weeks pregnant, 5'2". Diagnosed with PCOS before pregnancy, no medication besides prenatal vitamins from Nature Made brand. 1st pregnancy. In the US but English is not my native language.
30 weeker boy, 3lbs, 16in
It is my first time posting here so I hope it is ok. I have been going through a lot of guilt feelings and I need to understand whether it was my fault or not, whether I was ignorant when I should have been more knowledgeable. My water broke (PPROM) for unknown reason at 28 weeks, the day after an OB visit where everything was deemed good. I was hospitalized in the antenatal unit from there with multiple sonograms done, everything looked ok besides low but acceptable amniotic fluid. When I got admitted I got the magnesium infusion to protect the baby's brain vessels and steroids for the lungs. Plus antibiotics. At 30 weeks, labor started at 6am. Baby was breach, OB team told me they would do a rotation to try to have him head down around 9am. We knew nothing about that, thinking it was just routine, so we just said ok. They did it and baby was still breach. From 9am to 2am (17hours), baby had multiple heart rate drops but nothing alarming according to OB team. Contractions picked up in the afternoon and so did my white blood cell count: I had a placental infection. Around 9pm, they offered me a second rotation, which I kept refusing for hours and requested a C section as I was starting a fever and not feeling good overall. I was also only 4cm dilated. Finally, at 2am, they started preparing for the C-section. Baby was born an hour later, 3lbs and with a huge "tumor" going from his skull, through his back and to his buttock. All of his internal organs were shifted to the right, including the heart. The day/week is a blur as it was so traumatic. My OB called around 9am saying she cannot understand how my baby can have so many anomalies, the sonograms never showed anything abnormal. Several hours later, it turns out the "tumor" is a hematoma. Left lung kept collapsing in the NICU, phrenic nerve was paralyzed, grade 3 IVH. Fast forward a year later, he has cerebral palsy, hydrocephalus. At 12mo, he was diagnosed with craniosynostosis (he had a vault distraction at 13mo to correct it that was very successful), no respiratory issues that we know of. My main question is: is it common to have a rotation harm the baby so much? I had a sonogram the day before labor started and everything looked normal. Did I do something wrong that harmed my baby even though I was just laying in my bed or walking to the bathroom? Would he have been fine (as fine as a 30 weeker can be) without this hematoma? Is IVH grade 3 common at 30 weeks after all the magnesium doses? I have been on antidepressants that really did nothing, I have so much trauma related to my baby's 1st year of life and beyond. I have shed so many tears for inflicting him such a tough start in life. I know I need therapy but when I already have to take my child to medical appointments 3-5 times/week and still working full time, therapy is not something I can add to my schedule for now. I am just trying to understand what I did wrong. Was it bad luck? Was it something I have done? Thank you for taking the time to read me and answer my questions.

Here is a brief story of the last year or so: I had been working at a retail plant nursery for over 5 years, had worked in multiple departments and had picked up a fair amount of knowledge regarding plants even though its not a topic I'm passionate about. The job is something I just fell into and it was my first real job, and I am in fact 32. I had spent years in community college before then, could never get past the math hurdle when younger, and was mainly taking music classes.(if I can get past the math hurdle now, now might be the time to consider going back). I am a classical pianist, and very knowledgeable about classical music and I compose as well, but I do not have the heart I don't think, and maybe not the the level of talent or commitment or personality type to take it up professionally. But this is my passion in life. I love early keyboard instruments as well, like harpsichords and clavichords, and would love to learn woodworking to maintain and build them. I have had so many goals throughout my teens, 20s and up till now, that haven't had much practical use to me. Intense ambitions too. Now I believe I am being forced to redirect that energy and it is very hard for me. I am considering working at a retirement home, sending in an application to either be a server or something basic like that, while I finish up at community college. I have been without a job now for several months and live with my parents. I am not an undisciplined person really, in some ways I'm very disciplined. I practice all the time, and I have been a runner at times and meditated a fair amount. My body right now is very tight as well, and I have had to go to PT to do exercises. I fear I am very depressed although it may be largely situational. I am in a very deep hole and do not know how to get out. I know I need to take it one day at a time, and some days are indeed better than others. But I have absolutely no idea where to direct my energy. Therapy is simply not accessible, nor is career counseling. I have messaged a number of these professionals online and gotten no response. Another bit for background: I take a low dose of an antipsychotic and lithium. Lower than I used to take. Before I got my last job, I had been to the psych ward and gotten branded with the diagnoses schizoaffective, which is laughable now, because I take such a low dose and am fine. I have been addicted to pot in the past, but I no longer smoke. The last time I caved in was two months ago. It helps that it's not really at all enjoyable right now in my state of apathy and isolation. But I want to continue to stay far away from it, it doesn't help with memorizing music or general life motivation and is bad for my lungs.
I just don't know what my strengths are anymore, like I said, or where to begin. I was pretty good at the plant nursery with customer service, but boy did it drain me. I'd rather do more with my life. I wish I could focus this ramble more, but my level of motivation right now is so low.

I was diagnosed with bpd (borderline personality disorder) and bipolar depression I was diagnosed in 2023 but I’ve dealt with it since I was maybe 10-11 years old I was given a medication called lexapro and I had to take it once everyday It helped very little but at least it was something but my body got used to it overtime So I stopped taking it because I didn’t see the point and I also didn’t see the point in getting a higher dose because i genuinely didn’t wanna be on medicine I need some advice/help on how to cope/deal and control my bpd I don’t wanna be on medication and I have been to therapy and that didn’t really help either for me personally, I just need help I’m tired of this Any advice and help is greatly appreciated thank you for taking the time to read this<3
Gia-

I am currently prescribed Hydrocodone/Acetaminophen 5mg. My body seems to tolerate Hydrocodone to where there’s hardly relief. It’s been a month taking them and I have an upcoming appointment. My plan of care is the medicine route for now while beginning physical therapy.
In navigating what works for my pain, can asking what the next step up of medication is affect me negatively? I want to ask if it’s possible to switch to Oxycodone since I’m already on a low dose without flat out saying or naming medication for relief. How could I go about this and maintain good rapport with my doctor? Thanks!

Hi everyone. I have a complicated but probably very common situation with my weight loss issues. I have ADHD so there is an inherent insatiable need for dopamine. I do take ADHD medicine however I've been taking it since I was 8 years old and my body is used to it. I don't want to increase it because it's just a never-ending cycle of increasing due to developing a tolerance and I don't want to have too high of a dose. Due to the dopamine need I tend to want food a lot.
I also have cptsd from being raised by a malignant narcissist who is stalking me to this day and also PTSD from my adulthood in which I was "r worded". I noticed that after that point gaining weight happened and it has been incredibly difficult to lose weight due to a subconscious need to feel safe by being what I guess I believe is unattractive. I'm in therapy I'm working through these things, but that fear is something I know I'm still struggling with.
I also have a son who is six who has autism, a partner who has undiagnosed autism and is not as helpful as one could be. And I have absolutely zero family support. It has been years since I've had a single break from working either one to two jobs and also literally never having a babysitter. Trying to make ends meet, can barely afford rent, certainly can't afford a babysitter. Edit: I mentioned this because there is a stress eating component as well.
Now recently I lost 25 lb (I'm 5'3 I was 210 lb and now I am 185) in two months because we were so broke that I couldn't afford food (I made sure my partner and my son could eat, I didn't tell them I was sacrificing myself for that) but now things are better and I can afford food. I decided I would count my calories, my calorie app based on the rate at which I want to lose weight says 1553 is okay for weight loss.
However, on a regular basis I have been eating maybe 200 to 500 more calories a day than 1553. Essentially my weight has not changed. It's not decreased. It has not increased, which is good. But I have an insatiable desire to eat sugary and salty things. Every time my one part of my brain says we're going to avoid those things or eat them in small quantities, the gremlin in my brain takes the wheel and I eat those things that I was trying to avoid.
I'm wondering if anyone who has dealt with trauma, perhaps has ADHD, and/or has a tiny gremlin in their brain (I assume there's lots of us out there) can give me tips on how to crack down on myself and not cave when it comes to these cravings. How do I fight this gremlin, and win?

I first started experiencing mult. symptoms 3 years ago at 40 and they’ve gotten progressively worse.
Most notable are : mass anxiety, brain fog, hot flashes several times a day, itchy skin, dull joint and bone pain that comes and goes, crying jags and continual exhaustion that never wavers. My home always looks like a bomb went off and to complicate things I am the mom of a moderate to higher support needs autistic toddler who while very sweet and good nature is also sensory seeking and going 90 miles an hour every day.
I am desperate to feel better.
I went to my primary care physician 6 months ago and she was totally dismissive. Said she wouldn’t prescribe any hormone therapy - only as a last resort - laughed and said the last resort is to women who are on the brink of divorce and their husbands don’t like them anymore. And besides my family had a history of stroke”. (Um yes in their 80’s)
Today I went to a different doctor - same net work. I read all the wiki info here. I laid out my case and all the notes of symptoms I had experienced and asked about hormone therapy even if a small dose or at least progesterone cream.
He said no because of the risk of breast cancer and instead proscribed me Effexor. I asked him if there is ever a situation in which he would prescribe hrt and he said no - he would not prescribe hrt to anyone because it’s too risky. At least he ordered a blood panel and dexa scan but otherwise I’m at a loss
I’m not refusing to try other things first but I have already been exercising, eating better etc and more sleep and nothing has changed.
I feel like Im existing as a hollowed out version of myself - marked with jags of anxiousness or crying several times a week as my normal.
I just want my life back so I can show up for my kiddo better but also just life in general.
No idea what to do.. 😭😭😭

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I feel like my only hope is if I get on high dose antipsychotics or something to make the tranny thoughts go away
I am on a waitlist to see a psychiatrist what’s the best way to go about getting this? Conversion therapy is illegal here so that’s off the tables