Just for clarification, this happened a long LONG time ago, I was middle schooler when this happened, so not only are some details lost to the passing of years, but since this happened during a shutdown even more so. I’m making this post just to get this out there.
Many people on this sub seem to be more latediagnosed, but I wasn’t. I was diagnosed at the age of 8, because since autism and ADHD were super common on both family sides, my mom decided it’d be best to get both my brother and I tested. He has ADHD, I have both. After getting that diagnosis, my mom obviously contacted both of our schools so that we could recieve proper accommodations. Honestly, I remember it being great after, I noticed teachers helped me more, but my mom didn’t tell me I was autistic until I was 11, so I never knew why.
Then came a time obviously, that I grew up and went to middle school. My mom assumed that not only that my elementary school would notify the middle school of this, or even just that they’d do the bare minimum and check my files to see what I had and how that would shape how I acted. In middle school, I didn’t recieve any extra help from teachers despite having both an IEP and 504.
2 years passed in middle, and at the time of the event I’m describing, I was 14 in the 8th grade. I was heavily masking (although, everyone definitely noticed and made fun of me which I didn’t notice,) and I was someone who ate school lunch and not my own lunch. Lunch time was always a bit over stimulating for me, but the day it happened, they were serving fish. Now for me, the foul stench of fish is something that tipped me into either a meltdown or shutdown depending on where I was, and that combined with the loudness of the cafeteria I went into shut down. I sat down in the corner of the cafeteria, and when a classmate tried to ask if I was okay, I was completely non verbal.
We had to go back to class, and I was still in shutdown mode, so even as I walked along I felt extremely nauseous and uncomfortable. When I went into class, I was visibly discomforted, and my teacher picked it up. She yelled at me, and asked me to walk out of class. I heard her make a phone call, but due to my circumstances, I couldn’t hear her. All of a sudden, the school principal walked up to me with a wheel chair. I was super confused. My school principal was actually a really sweet guy, and he asked if I’d be comfortable getting in the wheelchair, and I shook my head no, because I didn’t need one and it made no sense. He had me get up and walk with him to the nurse.
This part was where it got really bad. Obviously, you’d think a nurse would actually look at a students information to verify some important notes, but these ladies didn’t. They brought me to a really bright room and begun asking me a lot of questions I didn’t answer (non verbal, again.) and don’t remember what they even were. The nurse who was with me was visibly and audibly mad at me and begun telling me I needed to answer her or else. I remember squeaking out some very quiet “no’s.” But I still didn’t really respond. At that point, she told me straight up that if I didn’t start talking she would have to “inject me with an anti drug serum (or whatever it’s called? I don’t remember what she called it) because I was “””clearly on drugs.”””” At that point it became a meltdown and I started wailing begging her not to do anything. She stormed out of the room and I heard her call my mom. When my mom came however, she was very clearly pissed at the nurses who would assume I was on drugs. When she found out that none of my teachers, nor staff, or those very same nurses who were supposed to check my files, knew I was autistic. She was even more mad at them. They had a long conversation, and my mom straight up told them there was no way I was on drugs. I don’t remember what happened after that besides my mom getting me McDonald’s after.
I don’t know why I often find myself reflecting on this event, but whenever anyone asks me to explain why I think the public school system is a joke and only harms autistic kids, this is what I tell them.

Around Thanksgiving last year, my 22 year old daughter Izzy started complaining about her back hurting. We just assumed she pulled a muscle or had a pinched nerve. After a couple weeks, the pain seemed to be getting worse. She went to urgent care on a Friday and they confirmed she probably had a pinched nerve. They gave her some meds. That following Monday (Dec. 18) she was in a lot of pain, so I rushed her to the hospital. It was her back and her left arm now bothering her. They blew her off and said that she was fine. I insisted that she get an MRI or cat scan done. Finally at my request they did a cat scan on her back and said they didn't see anything wrong. They said it's probably a pinched nerve, gave her more meds and sent us home.
The week of Christmas everything changed. She woke up each night covered in sweat. On the 28th, her heart was beating fast, she was extremely pale, and had two knots appear on the left side of her neck and one under her left underarm. I brought her to a different hospital.
When we got to the ER, they immediately took her to a room. Her vitals were extremely high (170 heart rate) from the pain she was in. They were considering that she could have meningitis or mono. They wanted to get tests ran right away. They admitted her, and did a spinal tap and MRI. 2 days later (Saturday) the doc said they found a large tumor on her spine. Can't say if it's cancer yet, she would need a biopsy first. They informed us that she would be moved that day to their sister hospital that specializes in cancer.
When we arrived, she was put on the neurology ward in a regular room. They immediately put her on a lot of meds. She was on so many pain drugs, (Oxy, Dilaudid, muscle relaxers, Morphine, Xanax, etc.) that I kept asking, "Is this end of life? Can she overdose from all these drugs?" They would respond with, "no, it's just to keep her comfortable and we're trying to get her heart rate down." On New years day they gave her Ativan. She responded horribly to it. It was a rough day. She was hallucinating and freaking out all day and night. The next day she told them to NEVER give her that again. They told her when we first arrived that anything she didn't want to take, they would respect and not put it in her charts to receive. They would put it under allergies. We assumed they would do so as they said they would.
They finally did the biopsy on Wednesday the 3rd. When she came back from surgery, she wouldn't wake up. She slept all day Wednesday and most of Thursday. I was really concerned.They kept adding more pain meds to her chart. I again was scared she would forget to breathe. That night she wasn't breathing properly and her vitals were going down. She had to be rushed to NeuroICU. They got her stable and explained it was from all the different drugs. They explained that it's trial and error. They're trying to figure out what works for her and they decided to put her on a drip line of Dilaudid. They still gave her other drugs but Dilaudid seemed to help her pain somewhat. They also said she had a spot on her lungs what looked like pneumonia starting.
All week she was constantly telling us that she was losing feeling in her legs and her left arm. By Saturday of that week she was paralyzed. They finally took her for an MRI and saw that the tumor had spread up and down her spine and to her ovaries, and it was stealing her blood supply. She would need emergency surgery asap. They of course came to explain what was happening and the surgeon informed me that Ativan would be used during surgery. I immediately told him no, and that she is allergic to it and it was supposed to be on her allergy list. I explained to him what happened when she received it before. On Sunday they rushed her into surgery and cut the blood supply to the tumor. It was too dangerous to try and remove any of the tumor. They didn't know if the paralysis was permanent, but they were hopeful that the surgery would work. It didn't we would later find out.
When she returned from surgery, she was out of control. She was violent and cursing at me. In 22 years I had never heard her curse, but she was fluent! She was hallucinating bad and kept freaking out. It was scary to watch. They decided to give her some meds to make her to sleep, to help her heal. For 2 straight days my baby screamed blood curdling screams, she would cry out "mommy, mommy" while she slept. She screamed so much and so loud that anyone in ear shot were questioning what was going on. It was heartbreaking to witness. I thought she was having a bad reaction to the anesthesia. I later found out that they were giving her Ativan anyway. They NEVER put it in her chart as an allergy the week before, and the doctor disregarded what I said about not giving her that. They had other options they could have used but he still chose to do what he wanted. I only found out because the nurse mentioned that she would be right back with her Ativan. The nurse had no knowledge that my daughter refused that medication previously. I informed her not to give that drug to her. She went and spoke with the attending physician who changed it to haldol and ketemine. That was Monday night. By Wednesday she finally calmed down from screaming, so they decided to try and wake her up.
When she woke up she could no longer speak properly, use her left arm, or move her legs. Her fingers and toes were turning black. They said it was from a certain med she was on. That it's normal. A lay person could see something was horribly wrong.
Everyday we would see up to 30 doctors. I say we, because I never left her side. One would say one thing while another would say something else. It was confusing and scary. We still didn't have a diagnosis. We just knew she had cancer. They suspected stage 4 but couldn't say until pathology came back. It was traumatic and a nightmare. It went from a diagnosis of a pinched nerve to stage 4 cancer in a matter of a week. WTF?
We finally got the diagnosis on Tuesday the 9th.. Stage 4 anaplastic large cell lymphoma. Very rare and aggressive. They said they were starting chemo immediately. They gave her the first dose that Wednesday night. We had hope. It was a rollercoaster of terror, but the doctors kept saying that she could beat this. I googled everything I could and prayed for a miracle. It's always been my girl and I, so I was desperate for her to live through this. She wasn't just my daughter, she was literally my everything.
By week 2, she needed blood on a daily basis. She couldn't eat or drink. She couldn't relieve herself. She couldn't move. She couldn't speak clearly to explain her needs or wants. Her breathing was shallow. Her vitals were not normal. They would go down and then jump extremely high. She was so out of it, that they had to come to me concerning everything. Her oxygen was dropping significantly and they had to keep changing out the masks and oxygen levels to help her breathe. They kept changing her meds and she had multiple complications from that. They couldn't find any good spots on her arms to put her IVs anymore, and her legs were so swollen that they couldn't locate a useable spot anywhere. They put it on her right side of the neck. During all this she had multiple medical emergencies. One example is they said that spot on her lungs wasn't pneumonia but they now suspected a small blood clot. That medicine she was given would hopefully help, the only problem was that medication was causing problems for her back surgery. A few days later we found out it was blood and it was completely filled up in her chest. She was drowning in her own blood. They couldn't do surgery right away because she would bleed out since her platelets were so low even while receiving blood transfusions. That blood was somehow going into her lungs. I was floored. Everyday I would ask about it and I was told it was getting better, nothing to worry about. In fact the doctor said that very morning it had cleared up significantly. Imagine my shock when the critical team comes rushing in that evening to do ultrasounds on her and tells me they suspect it's why her breathing was going downhill.
On Monday she was transferred to a MICU room on a different floor. This floor felt uneasy to me. There was death all around and you could see it. They said that this floor was where her main doctors were, so that she would get the best care. Now they introduce fentanyl to her med regimen. They explained it that it would help with her pain. She would be allowed so much every hour if needed.
The next day they decided to do the surgery to put a tube in her chest to drain the blood. She now had an extremely dangerous back surgery, staples running up her entire back with tubes, a huge scar under her arm from the biopsy with tubes, and now a huge tube coming out her chest. Her fingers and toes at this point were in a stage of necropsy. But they couldn't do anything about it. They would just have to fall off in time. It was devastating. My daughter was a trooper through out this whole time. She never complained or was negative. She was just scared when she understood what was going on. Honestly I've never seen so much courage in my life.
When it came to her pain meds she was only on fentanyl and Dilaudid drip. She would only receive it when she asked. That was her rule. She was scared she would overdose or become hooked on it and didn't want that monster on her back. She would be in so much pain but would just sit through it. Her vitals were better, but when the pain would become to much to bare, her heart rate would go into the 150 to 170 range. As soon as she got some meds it would go down to the teens to low twenty's.
On Thursday night she had a new nurse. He would administer pain meds even when she didn't request it. I saw him give her shot when she was sleeping. I walked in on him. I asked him if she requested it as I saw she was asleep and he said no. He stated he was trying to keep her comfortable. I asked him not to unless she asks. He didn't listen.Throughout the night as we slept, he would give her meds that she didn't even need. He gave her haldol. She only received that for two days after her back surgery. No one had given her that since. He would give her a shot of fentanyl behind it. I later found this out while talking with her doctors and from her records.
That Friday morning she started having these weird episodes, what later looked like seizures to me. Her vitals would drop and she would go into a deep stare. They blamed the meds. It was constant apologies for her being over medicated again. Even the doctor didn't understand why he gave her so much.She had 4 separate episodes before they (at my constant request) sent her to get a MRI done.
She had a blood clot in her brain. Again they said nothing to worry about. But after experiencing what we went through already, I was highly concerned. As I should have been. They kept apologizing and said they would change her medication up again. I told them it wasn't the medicine it was the nurse. I couldn't understand why he would give her two doses of haldol when she didn't need it. The nurse said my daughter was anxious and thought it would help. My daughter was sleeping so how could she have been anxious. I went off. Something in my spirit was telling me to get her out of there. But how could I when she was hooked up to all these tubes. She was suffering and I couldn't help her. The only thing I could do was use my voice to try and protect her and be her advocate. The next day Jan. 20th, I woke up after a couple hours of sleep, and I knew something was wrong. She was awake and trying to talk. Her vitals were back at a steady 170 with high blood pressure and a low oxygen number so I knew she was in pain. I could feel it in every bone of my body something was different that day. I felt my baby didn't have long as I thought cancer was winning. I called all of our family to come see her. I can't explain it. At one point I pulled one of her doctors out of her room and begged him to tell me what was happening. Shoot it to me straight. He kept saying she's always been critical but she would pull through. He had so much hope.
They gave her some meds to help bring her vitals down and it started to work again. Her vitals started going from 160 to 150. At this point she was having a brain scan done in her room to see what the episodes were exactly. She was awake but could no longer move from her neck down. Which had just started the 2 days before. She had a blood infection and they had to move the pic line from the right side of her neck to the left side but we're unsuccessful because she had obstructions there (2 huge tumors) They had to put the new line back on the right side in the back of the neck. I don't know what happened since I wasn't allowed in the room. I do know my daughter said after they finished, she wasn't able to feel anything but her face. She never turned her head again.
During that day she kept having flem and spit from the congestion she had due to the chest infection and surgery. I would sit there and suck it out for her. No problem, I had been doing it for days with no complaints on my end. The doctors were coming in and out constantly all day to check her brain test and at one point the doctor seeing me and my nephew take shifts suctioning her out said he wanted to try a new medicine she had never received. My daughters nurse interrupted him and said that she didn't think that it was a good idea. They went back and forth for a few minutes and I stepped in and said, it was fine, I would sit there and suction out forever if I had to. Something felt different in this exchange as well. In all of 24 days of being in the hospital, I never saw a nurse challenge a doctor. I immediately went to the computer, where the nurse had typed in the order for this drug, and googled it. The first thing that popped up, was not to give this drug to someone with high blood pressure or high heart rate. It causes a person's heart rate to shoot up high quickly. It was too late. They already administered it to her. Since her heart rate was already high it caused her to go into cardiac arrest. I just stood there in shock screaming is she in cardiac arrest? To which the doctor finally responded "I'm sorry, yes"
They ushered me and my nephew out of the room so they could work on her. After about 30 minutes they called my phone and told me she flatlined but they got her heart beating again. I went flying back in that room screaming at them. I refused to leave the room. She was now on life support, but there was no hope for her to ever wake up again. After consulting with my family and her doctors, and looking at where her vitals were, I decided to pull the plug. She passed within seconds. I feel like the doctor should have listened to the nurse, but his ego would not allow him to. I feel like he's somehow responsible, but at the same time I saw what was happening to her on a daily basis and what cancer was doing to her body. I also witnessed a lot of negligence too on their part. I've been going back and forth since January 20th, about contacting an attorney and seeing if I have a case. I requested an autopsy to be performed, because I wanted to know what all was wrong with her. They informed me they normally don't do that because of the cancer. I argued with them and said I wanted one anyway. I wanted to know what happened. I was trying to understand this whole situation. 25 days prior it was just supposed to be a pinched nerve, but it wasn't. They explained I would have to pay for the autopsy, and I was okay with that. The next day after she passed away, I received the phone call to give my permission for an autopsy. They said it would take a couple days and would let me know when it was finished so the funeral home could pick up her body.
I've been calling for months about the autopsy report with no luck. Here we are in May, I go to the hospital to get the autopsy results and it's all of five pages. It's not even an autopsy report. It doesn't even state her cause of death. It's just bullshit paperwork. All it mentions is the necropsy to her fingers and toes and her basic info like height and weight. I'm so angry right now. I have her medical records, and I noticed on the 19th of January they finally put she was allergic to Ativan. There's a lot wrong with this situation. I even asked for a CD of all her images, from pathology. What I received only two images come up. Everything else is blocked from opening. I know my daughter took multiple MRIs, ultrasounds,and CAT scans in those three and a half weeks. There's no way it's only two images.
I counted all the times the nurse gave my daughter pain meds that Thursday night and it was double what any other nurse had given her at any other time plus with other drugs she didn't need at that time. I found out that haldol and fentanyl is something they give to patients that's in end of life care. Which I was constantly told my daughter was not. Her death certificate states she passed from lymphoma related cardiac arrest. I'm just so confused on what to do. I feel like I'm letting my daughter down if I don't look into this further.
I'm sorry this a novel. I couldn't just ask a simple question with out the back story for you to understand. It was so much more believe me, this was the short version!
Do I have a case or should I just move on and accept my daughter died from cancer related complications? Thank you....

Hey guys 👋 Hope everyone is okay
As the title states, I've been recently diagnosed with ADHD combined type via Clinical Partners under 'Right To Choose' , and I just have a few questions....

1. Does getting a diagnosis under Right to Choose mean it's a Private or an actual NHS diagnosis ?
   
2. Clinical Partners don't currently offer titration under Right to Choose atm, what would be my best option (s) with starting titration?
   
3. I was diagnosed by a Psychiatric nurse, so I guess I've been Overthinking whether my diagnosis would be classed as a valid diagnosis or not as I wasn't diagnosed by a Psychiatric Dr 🥲...
   
4. Has anyone been diagnosed by a Psychiatric nurse ? or even by a Dr? via Right to Choose / NHS?, If so, were you able to start titration? Or getting shared care from your GP?? or what issues you had via getting a Right to Choose diagnosis ?
   

Thank you so much!

My seizures began in college my junior year of 2021 and I lost my athletic scholarship because I couldn't continue under my conditions. I've been to several doctors since then and still have no diagnosis of my condition. My girlfriend has been my nurse keeping me safe during and after my seizures as well as through my therapy process. It hurts that she has been handling our family financially ever since I was told I can't work nor drive until cleared by my doctor. I'm very thankful for her and my family as well pitching in whenever they can. I'm due to have more surgeries this year and would really appreciate some love from the community financially if possible. I've tried a gofund me but it went nowhere and that really hurt. I can't even receive stamps nor disability, Please, Please, Please show some love and help my out. My cash app is $Mcoleman33 and if you want more information on my situation just ask.

I benefitted a lot from the advice on this subreddit and used a lot of it to guide my approach to M3 year; now that I've had the chance to sit the exam, I wanted to create an exam write-up in the hopes that it will be useful to others. This write-up is lengthy, as I wanted to include advice for any new M3 students about how to maximize 3rd year, as well as some Step 2-specific strategies and advice.
A little about me: I am a non-traditional student (in my 30s) at a mid-tier US MD school. Pre-clinical grades were good (honored 2nd year, 0.5% away from honoring 1st year). Honored every rotation in 3rd year. I am a peer tutor at my medical school and was actively involved in tutoring 1st and 2nd year students throughout my M3 year and dedicated.
I am a big believer in students teaching students and the idea that if we all work together, we all become better students and clinicians. In that spirit, I welcome you to ask me any questions that you have below.

Overview

In general, my advice boils down to:

1. Don't try to use EVERY resource. Choose a few high-quality resources and really know them well.
2. Doing well on Step 2 (and shelf exams, tbh) requires active learning strategies and continually trying to think about what the next step would be. Practice questions are a great way to do this, but challenge yourself to go beyond what each individual question to build a broader knowledge base. That way, you won't only know the answer to that specific question, but also to a whole host of related questions.

General studying tips for 3rd year + dedicated
I am a big believer that the most effective study strategy involves four big components:

1. A question bank (UWorld) - gives you primary exposure to the material and helps to identify where your gaps are.
2. A system for continuously reviewing content - I used Anki (I discuss this more below). You can also use other strategies (note-taking, old school flash cards), but the important thing is that your review strategy needs to be ACTIVE (i.e., not just re-reading your old notes, but actively quizzing yourself and covering up the answers) and it needs to be CONTINUOUS. I did not pause any Anki cards during 3rd year, so by the time I got to dedicated, I had been actively, continuously reviewing content for months.
3. Resource(s) for primary sources - this is where you go when you need to refresh on pathophysiology, look up treatment/diagnostic testing for a disease, or understand the symptoms. I prefer UpToDate for this broadly, and used some additional resources on specific clerkships that I will discuss below.
4. Practice exams - NBME practice shelf exams ("CMS forms") and NBME Step 2 practice exams; do them timed to practice pacing.

A note on AMBOSS vs UWorld
A lot of people I know use AMBOSS and like it. Some people want an additional bank of questions to study from. I didn't personally use AMBOSS at all during 3rd year, and only used it for Ethics and QI during dedicated (and honestly, it was only marginally useful - may have gotten me 1 or 2 extra points on the real step 2 exam, but not more than that).
I think the smartest way to approach Q-banks is to make sure you have enough time to complete and thoroughly review at least one. For me, UWorld was more than enough to prepare well for each shelf exam and step 2 (honored every rotation). I think that a lot of people who try to use both AMBOSS and UWorld never finish either Q-bank in its entirety, or don't really review the Q-bank adequately. I decided it was a better use of my time and money to review only one but really know it well.
A note on Anki
Anki is a powerful tool that can really help with your long term retention, but it is dangerous if used incorrectly. I suspect that many people who don't find Anki helpful simply don't use it effectively.
The purpose of Anki is spaced repetition. In order for this to work, you have to keep up with reviews and you can't pause cards. I also caution students I tutor to be cautious of relying solely on a premade Anki deck; I used the AnKing deck, as well as this deck and a home-brew deck at my medical school.
During M3 year, I would start each rotation with UWorld from day 1, and as I came across each concept in UWorld, I would do a search through my Anki cards and unpause all the cards that related to that topic (so, for instance, when I got a question about diverculitis, I would then unpause all the diverticulitis cards). I found that doing this ensured that the new Anki cards I was adding were reviews of concepts I had just studied (via UWorld), so I was able to both reinforce the new content via Anki and also ensure that the new Anki cards I was adding were concepts that I was actually familiar with. I recommended this approach over the one that I saw many classmates using (just unpausing all the cards tagged for a clerkship at the start of the clerkship and "raw dogging" them, as my friend put it). It's also a good way to keep your daily new cards (and thus, your reviews) at a manageable number. On a typical day in 3rd year, I added between 50-100 new cards and averaged 250-350 reviews daily. I was nearly always able to complete my reviews while I was at the hospital each day, leaving my home study time free for UWorld.
More on how to effectively use Anki
A note on staying sane and prioritizing high-yield content
As others have said, I think that the best way to do extremely well on Step 2 CK is to approach M3 as a yearlong dedicated period. Doing well on Step 2 is not just about your preparation for the Step 2 exam, but also your learning during each rotation and your preparation for your shelf exams. Even if you're not at all interested in a particular specialty, there is a lot to learn from each rotation that will be valuable to you as a future physician. Additionally, each specialty has its own way of approaching medical decision-making, and paying attention to these patterns of thought can help you to reason through questions on exams, as well as be a better communicator with physicians in each specialty when you become a resident and attending.
As you progress through 3rd year, there are also a few things that I think it's wise to keep in mind:

• Remember that you are a person first and a medical student/doctor second. I put this first because it's the most important. It's hard to learn when your basic needs aren't being met or you're so anxious, stressed, or depressed you can't remember anything. Find something that keeps you grounded and whole and sane and make that a priority. For me, it's distance running. I ran nearly every day of 3rd year and dedicated (often at 3 AM, before rounds). I finished 3 marathons during M3 and dedicated, including running the Boston Marathon 2 weeks before I took step 2. Running relieves anxiety, gives me an excuse to step away from studying, and evens out my mood. In total, I ran over 2500 miles during my M3 year. I don't think I would have done anywhere near as well in M3 without it.
• Get really, really good at preventive care. The US Preventive Services Task Force guidelines are highly tested on all shelf exams and on Step 2, and there really aren't that many of them. Before my family med rotation, I made an Anki deck of the A and B recommendations based on the most recent updates and kept those in rotation through Step 2 (about 150 cards total). If you're at the beginning of M3 year, (or really any point in M3) I would suggest doing this right now. Every time you see a patient in clinic, think about "what screening exams should this patient have". If you get in the habit of always doing this, by the time you get to the exam, those screening questions will be free points (and there are usually a bunch of them).
• Try to approach every patient encounter as though you are the sole physician responsible for that patient's care. Formulate your own plan independently of residents or attendings. Ask questions about all these things in your patient interview, and present the answers to your attending. You will learn more if you push yourself to try to think about management from the beginning of 3rd year rather than relying on plans from your residents.
• Pay attention to sensitivity and specificity of tests. This is becoming a bigger and bigger deal on NBMEs and Step 2. Knowing sensitivity and specificity can help you determine whether a given finding in a question stem is significant or not.
• Look up every imaging test and diagnostic procedure you come across, whether in clinic or on a practice exam. A good rule of thumb for whether you understand a test is "Do I know when this test is appropriate, when it is inappropriate, and could I explain it to a patient?". I had a surgery fellow pimp me on when to order an ERCP vs MRCP; this stuff is important because it prevents unnecessary testing and allows you to get the most "bang for your buck", both in terms of diagnostic accuracy and scoring points on the "next step" questions on exams.
• Pay attention to thresholds for follow-up observation vs treatment. If a patient has a AAA that's 3 cm, you do serial ultrasounds and watch it clinically; if it's 7 cm, you operate. Many, many conditions have similar thresholds, and you should look for the differences in how you manage a condition based on the thresholds. Sometimes this stuff is buried in the UWorld explanations, so when you see it, make a flash card or add it to your review.
• Know the USPSTF screening guidelines like the back of your hand. There aren't that many of them, and it's basically free points on every single shelf exam + step 2. Make a flash card deck with the most updated versions on day 1 and review it throughout 3rd year. Especially high yield on FM + IM, but they appear on every shelf.
• Think about what things a specialty "cares about" when you're rotating on that specialty.
  • OBGYN: gestational age, STI history/screening, social/fam Hx of risk factors for gyn cancers (breast, cervical, ovarian, endometrial).
  • Surgery: is the patient safe to take to surgery (comorbidities, heart failure, coagulopathies, meds, etc)? When is surgery indicated (i.e., do they have to go now, or can they wait)? Antibiotic prophylaxis (who needs it, and what antibiotics)? Post-op complications (the "5 W's", leaks, nearby structures that can be injured)? Normal post-op care/patient safety (DVT prophylaxis, catheter removal, infections, etc).
  • Peds: developmental milestones/normal development/growth curves, rashes (pediatricians love rashes), upper respiratory infections, stuff that gets treated differently in kids (ex. febrile UTI), neonatal hyperbilirubinemia (basically guaranteed to get at least one question on this on any peds exam)
  • IM: Preventive care/screening, vaccines, hypertension, diabetes, heart failure, ACS, liver failure/cirrhosis.
  • FM: IM + Peds + OBGYN, with a heavy focus on preventive screenings
  • Psych: Pay attention to timelines; think of every psych disease as a continuum (i.e., <1 mo = brief psychotic disorder, 1-6 mo = schizophreniform, 6+ = schizophrenia, schizophrenia + mood symptoms = schizophreniform). Find something that makes sense to you for the personality disorders (I personally mapped them all onto Harry Potter characters and now I will never have to re-learn them).
  • Neuro: Differentiating causes of stroke, multiple sclerosis, when to get an MRI (answer: always get an MRI in neuro), different types of dementia

Subject Review

This section is intended for those who are starting or still in the midst of M3 year. If you're already in dedicated, this section may be less useful.
For all rotations, my strategy was generally:

1. Complete the UWorld Shelf exam Q-bank with 1-2 weeks to spare
2. Make/unpause Anki cards as I worked through UWorld
3. Take timed NBME practice shelf exams regularly throughout the rotation(I sat down at the start of each rotation and planned these out every 1-2 weeks so they were evenly spaced throughout the rotation). Get through every practice exam by the end of the rotation. Doing them timed is important because it helps you to practice pacing. One 50-question exam at 90 seconds/ question = 75 minutes total. I also wrote down the diagnosis for each question so that when I reviewed the exam, I could see whether any wrong answers were a problem with making the wrong diagnosis vs knowing the next step. Doing the NBME shelf exams also gives you a good sense of what the "pet concepts" that tend to occur over and over are (for instance, SCFE vs Legg-Calve-Perthes comes up shockingly often)

Order of rotations:
I did my rotations in the order listed below and I really liked this order. I know many people advocate for finishing on Internal Medicine, but I was very glad I started with it, because I think it laid a strong foundation for everything else. As long as you have a solid strategy for reviewing the IM content continuously throughout the year, I think it's a smart choice for the first rotation, especially because basically every other shelf exam will have 5-10 IM questions on it.
Medicine
Resources: UWorld (IM shelf bank + 1/2 of Ambulatory), Case Files Internal Medicine (did ~50% of it), USPSTF A & B guidelines, NBME practice shelf exams ("CMS forms"), Emma Holliday review
Advice: If you have free time 1-2 weeks before starting IM, get through as much of Case Files as you can. It lays a good base and helps you get into the mindset of IM. Once you start the rotation, crank through UWorld. I'd suggest trying to finish the UWorld Q's with 1-2 weeks to spare at the end of the clerkship in which you can review incorrects and/or shore up any weak areas.
Raw Score: 85
Neurology
Resources: UWorld, Case Files: Neurology, NBME practice shelf exams ("CMS forms")
Advice: Case Files Neuro is a little in the weeds, but it will help a lot with some of the more off-the-wall pathologies that aren't really seen in the UWorld bank.
Raw Score: 90
Psychiatry
Resources: UWorld, Case Files: Psych, NBME practice shelf exams ("CMS forms"). A lot of people swear by First Aid for the Psychiatry Clerkship; I didn't use it (but I think Case Files accomplished much the same purpose)
Advice: Pay attention to timelines + enjoy the psychation! This is the lightest rotation for most people. Take it in the summer if at all possible and enjoy the nice weather and free time. If you can, get it somewhere in the middle of 3rd year so you can have a little break.
Raw Score: 94
Family Medicine
Resources: UWorld (FM bank + 1/2 of ambulatory bank), Case Files: Family Med, NBME practice shelf exams ("CMS forms"), USPSTF A & B guidelines, CDC vaccination schedules
Advice: Try to take FM after IM, if at all possible. DO NOT underestimate the family medicine shelf exam. It is the broadest shelf exam, and it's heavily weighted towards prevention, so plan your studying accordingly. Know the USPSTF guidelines and vaccine schedules like the back of your hand (this is at least 25-30% of the shelf exam).
Raw Score: 85
Surgery
Resources: UWorld (Surgery bank + EM bank), de Virgilio's Surgery, NBME practice shelf exams ("CMS forms") for EM and Surgery, American College of Surgeons TEAM (Trauma Evaluation and Management) course book, Emma Holliday review
Advice: The surgery shelf exam focuses heavily on the pre- and post-surgical management of surgical patients, trauma assessment (hence the EM questions/CMS forms above), and knowing the indications for surgery. You will not be asked how to do a surgery on the shelf exam, but you will be expected to know when a surgery is indicated vs when medical management should be used instead (and also what that medical management is). De Virgilio's is a great and under-utilized resource that has a fantastic question bank at the end of each chapter. I would recommend reading at least the GI, vascular, breast, endocrine, and trauma sections (and honestly, as much of it as you have time for).
Raw Score: 85
Obstetrics and Gynecology
Resources: UWorld, Case Files: OBGYN, NBME practice shelf exams ("CMS forms"), ACOG guidelines, UWise questions
Advice: OBGYN is all about timelines (at least, the OB part is). Pay attention to gestational age requirements for diagnosis of various conditions. Know the various labs that are used to diagnose Pre-eclampsia with severe features, and really pay attention to risk factors for the various obstetric complications. As one nurse midwife I worked with put it, "The biggest risk factor anything in L & D is usually a history of the same complication". I didn't really find the UWise Q-bank that useful, but if you have extra time, it's a nice source of extra practice questions, or a good way to reinforce any trouble spots.
Raw Score: 87
Pediatrics
Resources: UWorld, Case Files: Pediatrics, NBME practice shelf exams ("CMS forms"), CDC vaccination schedule, Emma Holliday review
Advice: Know the general trends of pediatric vital signs (what's normal for an adult is abnormal for most pediatric patients and vice versa), pay attention to rashes and dermatology, and review these as often as possible. It's well worth your time to do a good review of all the glycogen storage diseases, inborn errors of metabolism, lysosomal storage diseases, etc that you forgot after Step 1. For this reason, if you can do Peds as your last rotation before Step 2 it's kind of nice...then you only have to re-learn all this stuff once. This stuff is fair game for Step 2 (and I did personally get questions on it on my exam).
Raw Score: 91

Dedicated Study

I completed my first pass of UWorld during my M3 core rotations with an average of 74%. I did reset UWorld and begin a 2nd pass during dedicated, but I found that the questions repeated a lot of content that I knew well, and ultimately decided it wasn't a good use of my time. I only completed about 20% of my 2nd pass of UWorld with an average of 92%.
My main resources during dedicated were NBME practice exams (I did 8-14 timed), UWSAs, and the Free 120. I also listened to some Divine Intervention episodes on my runs and reviewed the Emma Holliday shelf exam reviews (I had previously listened to these during my M3 rotations). Of the podcasts, I found the Divine Intervention Free 120 review the most helpful, and would strongly recommend listening to those episodes after you take the Free 120. It did a lot to help me with some test taking strategies that I used on exam day.
General advice for dedicated:

• Keep on a regular sleep schedule, even on your days off. I went to bed at 10 and got up at 6 every day, because I wanted my schedule to be close to what I would need to do on test day.
• Take days off. I took at least 1/2 a day off every week. I also ran a major marathon 2 weeks before my test day, so that was a very light weekend in terms of studying.
• Keep exercising and doing things you enjoy. For me, this meant running a marathon (something I do regularly). You don't have to go as crazy as I did, but do something to get outside and stay active. It will help you keep the anxiety under control and see the sunlight every so often.
• Take practice exams regularly and spend plenty of time reviewing them. I made a google doc to keep track of incorrects and assigned each one to a category of "why I got it wrong" (i.e., "overthinking", "knowledge gap", "guessed wrong of 2", etc). This helps to identify trends. I found that I have a tendency to overthink questions, so identifying this helped me to address this weakness and gave me confidence to go with my gut instinct on the exam.
• Don't be afraid to adjust your study plan during dedicated. I started a 2nd pass of UWorld, but after about 2 weeks of dedicated, I felt like I wasn't really getting anything additional out of it and I was remembering too many of the questions from my 1st pass, so I just stopped using it. I spent that time on other resources instead (more practice exams). Take the time to really analyze which activities are actually helping your learning. Don't just do something because that's what everyone else is doing during their dedicated.
• Keep up with your review strategy. For me, this was Anki. I spent 2-4 hours every morning during dedicated doing Anki. At times, I worried that this was too much time on Anki, but part of what makes Step 2 (and all USMLE exams) challenging is the sheer breadth of content. The best way to prep for this is to keep consistent with your review strategy.
• If there's a concept you dread seeing in a question stem, STOP, do not pass Go, do not collect $20. Take a second to go to a primary source (UpToDate, a textbook) and review that content. Make some flash cards and review it regularly.
• Practice your timing. I came up with my exam day break strategy at the start of my dedicated, and every time I took a practice exam, I practiced my break strategy (at least, the first 5 blocks of my break strategy). This made it very easy for me to execute on test day because I was already used to doing 5 blocks in a row exactly this way. I took my lunch break after block 5 instead of block 4 (because I liked the psychological factor of knowing the exam was more than halfway done). Coming back for 3 more was no problem on test day.

My practice exam scores:
CCSE: 254 (my school requires this, and it was given a few days after the final shelf exam, right at the start of my dedicated period)
NBME 9 (30 days out) 269
NBME 10 (21 days out) 268
NBME 11 (18 days out) 262
NBME 12 (15 days out) 251
NBME 13 (7 days out) 264
NBME 14 (2 days out) 264
UWSA 1 (25 days out) 254
UWSA 2 (9 days out) 268
UWSA 3 (5 days out) 266
New Free 120 (3 days out) 85%
Predicted score: 265

The Day Before

Just take a break, for the love of all that is good. I went for a run, watched some old TV, read for fun, had a nice pasta dinner, and tried to go to bed early. Laid out everything I needed (lucky t-shirt, snacks, testing permit, ID, keys, etc).
Of course, I ended up tossing and turning most of the night and slept very poorly. When I woke up, I considered trying to postpone my test, but ultimately I decided I just wanted it over and done with and I wasn't willing to wait any longer. My point here is that even if you have anxiety and/or a single bad night of sleep before the exam, you can still do very well if you've done the work. As we say in the marathon world, trust your training.

The Test

Got to the testing center 45 minutes early. Made sure the last thing I did before going through security was to take a bathroom break. Brought plenty of snacks, headache medication, chocolate, and a healthy and delicious lunch (I think there's some psychological power in knowing you have a delicious lunch awaiting you).
During the exam, I took a break of at least 5 min after every block. Personally, I found the mental break was extremely helpful. On the whole, I found the exam to be quite reasonable.
Step 2 CK: 277
My last piece of advice will be that I think doing well throughout third year is the best thing you can do. If you've had a break after 3rd year or you are an IMG or someone coming from a non-traditional program, doing a thorough content review with the CMS forms before starting Step 2 specific practice exams is a good idea.
Ultimately, I think the most important things are:
1.) Choosing a FEW, QUALITY resources to review
2.) Continuing your ACTIVE, CONTINUOUS review strategy
3.) Keeping a consistent schedule with time for sleep, healthy eating, exercise, and something you find fun (ideally something other than TV).
4.) Staying off Reddit. Really, I mean it. Especially during dedicated, it's just a black hole of anxiety and angst and you should avoid it at all costs. Come back after you get your amazing scores and pay it forward to others.

I was seeing a psych NP in a military healthcare setting when I was put on my medication; and subsequently taken off them when I got pregnant. We then moved as I was medically retired from the military for my diagnosis, and now in our new town, I see the VA for my mental healthcare, a therapist now and I am working with a psychiatrist to get back on meds when baby is born. I go to a local OBGYN as my VA doesn’t have their own OBGYN care. It’s a little rough without my meds but I get through, and that’s exactly what I’ve said to all the OB staff I’ve interacted with. So today, I’m viewing my MyChart, and I notice that “irritability and anger” were added to the “health problems” section. I’ve definitely never reported that to the nurses or midwives, I’m actually doing fairly well, if anything I experience more depressive symptoms but I didn’t even mention that to OB as I really prefer to discuss my mental health with my VA team, and only offer pertinent info to my pregnancy to other providers. So I have no idea why that was added, the only thing I can think of is them making assumptions based on my bipolar diagnosis and just adding stuff, without ever even discussing it with me. I tried to think very objectively and ask myself if they could have put that based off how I was acting in an appointment one day, and I genuinely cannot think of a time when I came to an appointment irritable or angry. Even if I had, I don’t see how it’s appropriate to note that without talking to me about it, especially when the visit summary notes for the day that it was added don’t mention anything about my mood.
My concern is being labeled as a difficult patient and treated differently before I even walk through the door, when pregnancy is the time in my life where I need the most sensitive and compassionate care. My bipolar diagnosis is noted in my charts, and I have no problem with that. So I don’t see how adding in stereotypical descriptive words associated with my disability does anything to inform my healthcare, it can only really cause harm. And I saw this immediately, as one of the nurses or medical assistants was definitely cold towards myself and my family from the moment she walked through the door. I can’t imagine feeling the way I felt in that room while trying to deliver a baby. I contacted patient relations for the hospital the practice is out of, and they told me that my options were to fill out a form asking for the notation to be removed from my records, which would be sent to the provider who entered it to approve or deny, or to address it with the provider at my next appointment. They also wouldn’t tell me who entered it, as I’ve seen a different nurse or medical assistant and a different midwife for almost every appointment. I’m really trying to look at this from a clear head and hope that I’m not just here proving them right but I’m just very upset by all of this.

Surgery was Monday morning and I've been stalking the op notes and path reports as they've come back. I had dense adhesions to my abdominal wall from the uterine fundus to my bladder, endometriosis over the back of my uterus and uterine ligaments, suspected adenomyosis, and it weighed almost a pound. Taking down all the adhesions was an extra 40 minutes. Dr. told me she has no idea how I was living that way. Because it was so involved, I've got some kind of extra material over the vaginal cuff to stop further adhesions. And due to a darn miracle, it was still laparascopic. My uterus went up and stacked the fibroids like big blocks, so it juuuuust fit vaginally. She said when she got in there, everything was so stuck together that all my organs had to be freed up. My uterus and bladder were fully trying to be one organ. I'm so glad I picked the surgeon who took the extra 40 minutes to untangle the whole mess and remove all the adhesions. I kept both ovaries, no bladder or bowel issues. She gave me a post-op diagnosis of pelvic adhesive disease. Pathology all came back benign (yay!) and confirmed fibroids, endometriosis, and adenomyosis. I only lost 25 ccs of blood in the whole surgery, which is just mind blowing. My wedge pillow set, heating pad, and hysterectomy pillow have been my best friends. That weird star-shaped pillow with straps...I wondered if I'd use it. I've used it non-stop, for coughing, as a shield from rambunctious kids and pets, to hold ice packs, and honesty the bit of soft, gentle pressure feels more secure somehow. Pop my cell in the front pocket, and off I shuffle. It'll be amazing in the car also. I used a cane the first few days because I am EXHAUSTED and felt so weak, but I think today it can retire. I've peed (first few were not fun but ok now. Just getting urge back and not having to schedule my toilet trips), pooped (I screamed with first post op poop. Enough said.), sneezed (better today but still not fun), showered (smell MUCH better.) and am doing way better. Pain is manageable with ibuprofen and tylenol. That said, the threat of vaginal cuff tear keeps me in check. I'm a nurse and worked in OBGYN and can confirm there are reasons to follow instructions. The more energy you put into proving you are some kind of superhero, the more energy your body has to divert from healing. Those stitches can and will pop, you can end up with another surgery to fix your newly minted vagina, new adhesions can be made, neither is rare and doesn't take a lot, and that will NOT be me. So... I will walk a bit daily, and rest as much as I want, and not push it. I'm thankful I had a surgery that makes it easy to forget how much my body went through and is healing from. And I will show it by embracing this time and being gentle with myself. We only recover once if we do it right. I may never have another opportunity to be this gentle with myself with everyone on board and supporting me. It's peaceful and I'm grateful <3 Positive healing vibes to all! Oh, and Happy Birthday to me and anyone else born today!!!

• Last year, in April 2023, I did an incomplete luxation and initially doctors thought I just had a meniscus tear. It turns out that I have congenital deformations (too high knee cap, abnormal form of knee cap, cavity of the knee not deep enough (trochlear dysplasia)...). This was a first shock because I never expected from a such "tiny" incident it was a much deeper issue.
• This year, in mid April 2024 I began to feel my bones slide 3-4 times a week. Electric shocks sometimes until my toes, constant pain even when I rest. I can barely bend and unbend my knee. When I stand up for too long, walk for too long, sit for too long, knee is blocked and very painful. Swelling. I knew something was terribly wrong. For this reason, I came back to my homecountry to check with a doctor and do a scan. I had the results yesterday evening. Now my knee cartilage is injured (grade II). Cartilage doesn't regenerate. Hence, it won't heal or get better, it can only worsen. The speed of my deteriorating condition worries me, in only 1 year I have all these issues ! I was starting to accept my dysplasia diagnosis.
• _____

I'm only 27 years old. This year I finally got admitted abroad into an European medschool after a difficult and competitive medschool entrance test. I was beginning to realise my dream. Now, I'm worried about the future.

• I have a nursing training, what if I have surgery or I can't stand up for long enough ? (if I don't pass the nursing training, I can't pass an entire module of lessons Informatics + English + Work and safety + nursing training. I need to pass everything if I want to officialise all my grades in each subject of the module.
• Next year (2nd year of medschool) ? Surgery recuperation is long, minimum +3 months and disability office said I'll likely won't even have videos of my lectures. I'll miss everything.
• I'm supposed to take the plane tomorrow to go to my last week of lectures (mandatory attendance) and pass 2 exams. All my lectures are located on a floor without any elevators, only stairs. It will further deteriorate my condition and I nearly can't use them. Made of slippy material. Use crutches ? I could, but the problem is I have dysplasia to my left knee as well, just less serious than the right knee.
• Yesterday hospital refused to give me an injection of corticoids despite having the bottle of medicine just because it wasn't explicitly written on the family doctor prescription. It was on the radiologist prescription. It was my hope to be free of at least a bit of the constant pain. Lost hope. __ My life isn't an easy one and everything accumulates. Was bullied for 7 years, from age 9 to 16. Still have post-traumatic stress disorder because of it. I face severe depression and only found 2 days ago (I hope) a correct mental health professional. No family, no doctor, no one helped me when I was a kid. Ignored or blamed at most.
  
• Family doctor, psychiatrist suspect also an undiagnosed ADHD and it would explain why I faced difficulties as a younger child, I was even told I couldn't achieve anything in life by elementary school teachers. I was excluded from social activities of the school by adults, abused even sometimes.
  
• 3 days ago, specialist in occlusion dentistry detected several severe problems with my jaw.
  
• Despite being top of the year of my class, I was rejected from medschool in my homecountry because of covid and being the first year they tested a new course to get admitted into medschool. They changed some rules 3 days before my exams and was fucked. It happened 3 years ago and I'm still hurt by this. Especially because at least they provided recorded lectures, which would be so useful today.
  
• ____
  
• My life feels so unfair. I'm strong, I can endure, but I think human psyche can't hold too much stress and pain if you are never given the chance to relax even for one month. I'm pissed. I'm desperate. I'm scared. I just wish some people could understand how difficult it is to be emotional neglected as a kid, blamed for issues (if ADHD) I didn't decide for myself, the bullying to be so severe it causes me trauma and depression even years after, receiving a lot of medical diagnosis in only one year. It feels too much. I'm tired. Please let me enjoy life for once !
  

Hi,
TW: baby loss, neurodivergence late diagnosis, mental health.
My partner 23/M and I 23/F have been together since we were 16. Our lives have had a lot of changes and been pushed in different directions.
When we were 21 we were both working very well paying jobs. We had an unplanned pregnancy so we used some of our savings to start building a house. We ended up losing the pregnancy at 14 weeks. We’ve moved into the house a few months ago. Cost of living has gone up significantly, we’ve gone from paying 1600 AUD per month to 2700 AUD per month for our mortgage and 400/month for our car.
Now here is the tricky part. My partner became extremely burned out in the well paying job and realised he needed to make a career change to something he enjoyed. Paired with his autism diagnosis and some mental health issues, he had a lot to figure out in regard to managing his needs and learning about himself.
We spoke about it and decided that he should study and find a career path he could be devoted to. (Some workplace environments can be extremely overstimulating, and he has a strong desire to help others, and a passion for animals) Together, we found some attainable studies and made a plan for him to study for the next 2 years to become a veterinary nurse. I agreed to support us financially during this time. Once those 2 years passed we’d both work again fulltime and begin saving for travelling etc.
Now, my partner is enjoying studying vet nursing so much, that he would like to become a Veterinarian. The part of this that scares me is that these studies will take 6 years to complete. I support him with this as an idea, I’d love for him to pursue something where he can challenge himself and work in such a rewarding field.
The part that worries me is that the cost of living is expensive and we’re not getting by as easily anymore, especially with the 1 income, even if my income pays kind of well.
There are other things I wanted for us in our 20s before we settled down. I don’t want to feel like I’m waiting for our 20s to be over before we can even start thinking about travelling, or children or marriage. As well as the cost of studies and student loans. Studying to become a Vet will be even more of a time commitment. At the moment he can work 2 days while studying 3 days and 1 day of at home studies.
I study casually outside of work (Logistics), online so that will help me with my current field. I guess I’m wanting advice on what we should do. We bought the house and car during a time where we didn’t know we would lose our baby, or that my partners depression would get so bad, or he would get his autism diagnosis. He never uses any of his struggles as an excuse, just a better way to understand himself and try to accomodate himself.
I get scared that this isn’t the life I want for myself anymore. I know that plans change, I’m adjusting. I wouldn’t rather do life with anyone else other than my partner. I’ve been thinking about getting a FIFO job, this will increase my workload significantly, jobs are hard to get but would help with the financial side significantly. I just guess I feel a bit sad about the restrictions these studies will place on our lives for the next 6 years.
Just FYI, I acknowledge both of our struggles over the past few years and I don’t want to minimise either of our experiences.
I guess I’m wanting advice on any of this. If my partners struggling and I can’t get a better paying job, should we rent out our house? I’ve been seeing more young people buying a house and renting it out while they rent an apartment closer to studies or something.
Has anyone been in a similar situation with learning of partners neurodivergence several years into a relationship? His capacity to mask and go through challenging experiences has lessened with time, which I’m fine with, as he is a much happier person, and communicates his needs a lot better.
Have you and your partner been at very different places in your relationship and how did you get past this?
Thanks all.

Feeling an array of emotions on my diagnosis of ADHD - combined type today, though it hasn’t come as a shock, at all. Lol.
First suspish memory I have is being 4yo and saying to my mum “my brain feels like it’s an antenna picking up on all the radio stations at the same time, I can’t turn it off or turn it down and it’s SO. LOUD.”.
Unfortunately, I went through a significant amount of trauma as a child just prior to puberty, which continued for years, so ADHD was overlooked as I was diagnosed with a variety of behavioural conditions, such as PTSD, BPD, Manic Depressive disorder blah blah dadidi fucking blah…. A common issue apparently, particularly in women.
I’d been wondering lately why I still hadn’t managed to get on top of my mind, after over a decade of psychotherapy, yoga, meditation, clean eating (ofcourse all which fluctuated, because ADHD lol), and self enquiry (except this one was consistent because the inner critic never rests am I right?), like why the heck do I feel like there is something literally happening in my neural pathways of my brain that is outside of my control??? Ohhhh wait, because that’s genuinely the case.
So I’m processing all of this, all of the lost time, the regrets, which could’ve been avoided had I the right support systems in place, the little girl who was brimming with creativity, life, and magic that couldn’t fully realise her potential due to her brains genetic inability to channel all of her gifts in an efficient and empowering way… really grieving her, and all of the times I was led to believe I was intentionally being a “bad” person and choosing to make dumb mistakes, despite having a high IQ, pure intentions, and trying.so.damn.hard. To just get the basics done. Internalising all the criticism of my elders, teachers, peers and that becoming the over arching inner voice I’ve harboured the majority of my life.
I am exauhsted. I am angry. I am so so sad, and I am relieved, and grateful, to finally have clear answers and options, a chance to finally put my finger on the tuner of my brain and quieter all that noise.
Jeez. How’s everyone else’s diagnostic journey been?
How have you managed the grieving process if you had this experience too?
Did you release your regrets, your shame, and make peace with your past? How?
What happened to your inner critic and all the noise after your diagnosis and treatment?
I have so many questions and feel no long so alone after having felt isolated most of my life by this condition….
Any advice, sharing of experiences etc is deeply appreciated x

As a patient and a pharmacy student getting scarily close to graduation, I have endless gratitude for the ER staff I’ve both worked with and received care from over the years. You all are truly incredible and deserve to hear it more. More details below if you’re curious, but TLDR: as a patient living with chronic illness, still newly diagnosed, you all made such a difference in my life and I will never forget your kindness when I was scared, confused, and alone at age 20. I finally got a definitive diagnosis over the course of two years and many specialist visits. That would not have been possible without the thorough work-ups I received in the ED to ensure I truly was stable when it wasn’t clear. You all are my “why”: why I manage to get up at 5am for weekend shifts when I’m in school full time, why I took an extra non-clinical year in pharmacy school rather than leaving the PharmD program after my diagnosis, why I now understand how to manage the symptoms that once scared me so much.
I’m going to actually write a card to the ER staff since I usually go to the same ED each time, but hopefully I’ll reach a couple of people here too. Thank you to the attendings and residents who took so much time to understand my history and concerns, the nurses who did everything under the sun to help me feel safe and comfortable, the techs who did my imaging and EKGs, the EVS staff ho made sure my room was fully clean. I know some people are rude and angry when they are in pain and it is a very challenging experience to deal with. As a young woman coming to the ER alone, those “little things” mean the world, and so do the big things. It is such a relief to get to go home knowing I am stable and feeling a little better, even when I don’t know the exact cause.
If you’re curious why I look up to the ER staff specifically as a pharmacy student and a patient, here’s some background. My PCP and specialists have taken great care of me, but you all were there for the times I was the most desperate and terrified, and made sure I got the resources I needed to follow up with that team. I’ve been a patient in the ED more than I would like to admit, which is ironic because that’s the department I visit the most often in my work as a pharmacy tech/intern. I’ve had the chance to meet many of the ER nurses and a handful of the paramedics, EMTs, and physicians in my city—some as a patient, some as a colleague, others as friends. My hospital is a level 1 trauma center, one of a few in the area. Due to proximity, we tend to receive a bulk of the very sensitive trauma cases (GSWs, etc.) to minimize prehospital transport time. I’m grateful that I’ve had the chance to learn from so many of you in advance of my clinical rotations.
I’m sorry that you experience such a high rate of poor treatment by patients and difficult working conditions. We see you and appreciate you, especially in pharmacy. The work you do matters and changes lives, and I hope you get to hear that more. Those with the worst experiences tend to be the most vocal, and that contempt and anxiety gets magnified in certain chronic illness communities. I’m grateful this thread exists because I’ve also wondered how to best express how much the care I’ve received has made a positive impact on me.
Thank you all for treating me with kindness and respect when I’ve had to seek care for symptoms secondary to chronic illness. I know the ER is really not meant to manage chronic illness symptoms. I work full-time during breaks from pharmacy school and often have to finish tests and assignments during that time from what I miss when I’m too sick to attend class. When I can’t get a same-day appointment with my PCP office, or urgent care won’t see me due to liability, I am grateful I can get the care I need before I get to the point where I actually get admitted to the floor or can’t push through my symptoms enough to work. Thank you for always figuring out a plan and working with me to help reduce my time in the ER when I’m not getting paid to be there. You all rock 🩷🩷🩷🫡🫡🫡 Also, I probably doxxed myself because my writing style + life experiences are incredibly distinct but oh well, it is what it is
Also if someone wants to let me know when I should say ER vs ED that would be cool but that’s a separate issue 🫶

She had necrosis in April and miraculously was able to recover from it but she's not herself anymore. She has heart failure and a UTI and has been in the hospital 5 weeks. She's 79 going on 80 and has been dealing with chronic pain and lupus and depression many years. Many days She's prayed for death.. I think death is near and answerimg her calls.
She's never had a major health issue like this.... I asked what's gonna happen to her.
What is going to happen to Grandma? Reversed world
I think it's saying she's going to die but not as planned? We always hoped she'd die at home, from old age. I think she hoped for that too. It may be abrupt and even tho she is terminal I think it's gonna be unexpected. I asked if it will be soon and I got temperance I think its telling me not to focus too much on what will happen and be grounded while also in touch and aware with what will happen. When my best friend was dying last year all I could think about was how he was dying and he would be gone from my life. His last months I spent mourning him even tho he was next to me. I regret spending so much time grieving Brownie so much when we still had time to make new memories. I think this time the universe is telling me to not go to that extreme of anticipatory grief and try to be more grounded this time.
Will it be painful? I pulled 10 of cups. So no, I don't think it will be. I think maybe she will feel very loved and surrounded by us.
And I asked what I should be focusing on I got the 4 of wands. I think its telling me to focus on my future and my journey that I've made to come this far. I think it was telling me to put the deck down lol in the past I have used the tarot obsessively for hours and hours when going through difficult times in my life. Anyway please share your interpretation.

Hi everyone! I'm new here, 40F, live in the mid-west (US). I was recently diagnosed for anal cancer.
TLDR: Story of my pain, how my PCP listened and cared, and where I am at with my diagnosis.
In my profile, you can see I have 2 posts in hemorrhoid because I seriously thought I had internal hemorrhoids and it was becoming painful. There's more details than what I posted but moving on.
The middle of April, I finally pulled the trigger to get myself a PCP to 1) impaction/ constipation. Major diarrhea before then 2) the pain in my butt that I thought was a hemorrhoid. "Hemorrhoid" pain started last year August-September.
Literally doing the preventative care check-ups to see if anything else was going on since it's been forever. GI-PA consultation for combined colonoscopy & endoscopy for major changes in BM. I agreed. They put it through my insurance and got approved right away. I waited ~ 2 weeks for scheduling and nothing. Pain: 6-8 almost every two days. Especially after a BM. It would drop to 3-4. On days with the most pain: night sweats, chills, couldn't go to work, and bad anxiety of the pain coming back and never healing.
Breaking point: Last week I went in for a pap. They gave me a sheet to fill out about mental health. I cried silently as I filled it out and gave it back to the nurse. I broke down sobbing and told her everything. I couldn't sleep, couldn't eat, couldn't work, and all because I was in so much pain, I didn't want to wake up if I ever fell asleep again. Nurse rushed to tell my PCP. PCP comes in, told her that I was approved but haven't heard back from my GI-PA for scheduling and I needed to know what is causing all this pain.
The HARD PUSH: PCP pushed for the combined colonoscopy/endoscopy and I got in that Friday. Came out of the procedure and talked to the GS, he told me I had a lesion from my rectum to my anal canal. He said, it could be anal/rectal cancer and the medicines right now can help heal that. Then he said, it could be a hemorrhoid, but we won't know until the biopsies come in. He looked like he knew what it was and didn't want to say anything. As someone who also works in the science field, I knew he knew something because he does this all the time. Just like I would, working in a plant laboratory. I was also told I have a peptic ulcer. PCP contacted me about my pap. I am positive for HPV.
This past Tuesday, I had an appt for a colposcopy. I couldn't go through with it. Speculum was pressing on my pain. 8-9/10. I hyperventilated and almost had a panic attack. Cried when gynecologist and nurse left the room. Took me hurting and limping out of the building with tears in my eyes.
Two days later, yesterday: followup with my GS and told me I have anal cancer. Told me about my options and that I won't know what stage I'm in until I get all my scans. He then told me he had two gentlemen come in with the same symptoms, worst tumors than mine, and pulled through.
Literally, so compassionate and understanding while explaining the process; not to forget to mention, also being strict about fixing the ulcer before other major procedures happen; ulcer meds with antibotics for H. Pylori infection. Depending on the extent: chemo, then radiation, and last resort surgery. My team and I are now waiting on my insurance's approval for more scans. Colpscopy will have to wait until further notice.
My care team has been exceptionally efficient, compassionate, and caring. They have continued to ACTUALLY LISTEN to me and advise me when I have questions. I could not have been more blessed for my team.
My hope: I hope to meet a new community that can also understand what I am going through, will go through, and give advise about how to pull through and any set backs that happen. Stay safe and as healthy as can be.

I’ll start by saying I really really hope I don’t have thrush again, but I have a possible suspicion.
This month I’ve started producing enough to start freezing- at first just 2-4oz a day, but I’ve had a couple days lately that I could freeze 8-12 oz. Today I saw a lactation consultant and the feeding physical therapist I’m working with to try to transition to nursing, and mentioned my disappointment that if I indeed have thrush again I’ll need to toss my last could days worth of milk, and they were both taken aback and said they’d never heard of that being necessary.
I thought the rule was that you can use thrush milk while you and baby are being treated, but not freeze it for later? Would you use it? And how positive would you need to be about the diagnosis before tossing the milk?
I will add that I never had any actual diagnosis of thrush the first time, I had a horrific experience with a doctor at my OB practice who was dismissive of my pain, didn’t seem to care that I hurt so much I couldn’t hold my baby, told me “most doctors don’t believe thrush is a real problem” and said it was unheard of to prescribe 10-14 days of diflucan. I begged, because he offered me no other possible diagnosis to explain my pain, and I felt a lot better after taking it. I’m trying a topical antifungal for now because tbh I’m afraid to go back to the doctor after that experience, even though I’d request to never see that specific doctor again.

My(32f) grandma(83f) has been showing signs of dementia and is in poor health because of a recent fall and arm break. My Mom (61f) is in the process of getting her moved out of her house and into a nursing home where she will have supervision and a better quality of life. This means downsizing and selling a lot of her things. My grandma is an avid sewer and crafter and because I’m the only person in the family who enjoys sewing and really appreciates her craft and skill in quilting I inherited all of her sewing stuff. I took all of the pieces that she had already started working on and some good basic fabric that I can use to make a few quilts and also a bunch of tools that I can use like scissors, needles, thread etc. the rest (and there’s a lot of it) I left for my mom to sell at a garage sale that will help pay for her nursing home and general expenses. I offered to organize the fabric that I didn’t take into different categories so it could be more easily priced and sold. My mom said not to bother, that it would all get handled. Today was the first day of the garage sale. My mom just texted me and said they’ve made over $1000 in the first day and they’re pretty happy with that. I asked her if she sold any of the fabric yet and she told me that they were giving the fabric away to anyone who wanted it because “that’s what she would have wanted”. I feel completely and utterly betrayed by this. Not because I want the fabric, but because it feels like they aren’t valuing this huge lifetime passion that she had. Giving it all away for free feels so incredibly disrespectful to both me and her that I am breathtakingly angry right now and told my mom as much. I don’t know if I can even be friendly to someone who disrespects the passion of a loved one and who so fundamentally doesn’t understand where I’m coming from. Am I being a crazy asshole? I know that anger can be a part of the grief process and everyone grieves differently but this already feels like something that I will never forgive her for. Are there any quilters or crafters out there who understand what I mean? Am a just grieving and letting my emotions get the better of me or is this completely heartless behavior? I feel completely powerless to stop any of this.
Update: To answer some confusion that people have: I don’t have unrealistic expectations about how garage sales work. I wasn’t expecting to get top dollar for any of the fabric, nor is it bad old fabric that’s been improperly stored. This is all good fabric that I wanted people to be able to use as I could not take all of it. It’s not that it was given away because it wasn’t appealing to buyers.
I am not mad that people took it. I’m mad she isn’t being compensated.
I’m mad that my mom GAVE IT AWAY at a garage sale. I left it in the expectation that my mom would sell it for SOME amount of money even if it was well below the market value. I offered to price all of it, and organize it so that she didn’t have to because I knew she didn’t appreciate sewing. She refused my help and said that she would take care of it. I left a lot of really good prices knowing that they could sell and that proceeds would go to my grandma.
My mom is well off and is not struggling financially at all. She will also be renting out my grandmas house which will almost entirely cover the cost of the nursing home.
Some people have said it’s my fault for not taking it, and I agree with that at this point. If I had known she was going to give it away to strangers I definitely would have taken all of it and sold it myself or even passed some of it to other people in her life who know her and are quilters. It feels flippant and callous to just give it away to strangers. I was under the impression that 1) SOME money would be going to my grandma, as is fitting and 2) people would still be getting a good deal on some nice fabric. People were very happy to get free fabric and I can’t blame them. My Grandma was never really appreciated for her skills and was a very humble and kind person. And you know what, she probably would be totally happy to just give all of her stuff away which is why I’m irate that she isn’t being compensated at all. She should get some of what she deserves for the value of her things ESPECIALLY because it was things associated with her passion and art the way she expressed herself. It feels morally wrong. It feels like “passion = $0 = worthless”.

I've (32F - 140ish lb - 5'7") been in chronic pain for my whole life. I've been diagnosed with fibromyalgia, CFS, bipolar 2, adhd, scoliosis, cankor sores, and something about sores in the abdomen (sorry poor word recall). Occasional ovarian cyst ruptures. I hsve had one child, pregnancy was fine but developed HELLP at 38 weeks and had to be induced. I wear glasses, but my eyes are healthy (I get them checked regularly). Currently I'm on:

1. I have a hormonal IUD
2. Duluxotine 90mg
3. Vyvanse 50mg
4. Pregabalin 150mg 2x/day
5. Lamotrigine 200mg 2x/day
6. Zoplicone 5mg
7. Magnesium 500mg
8. Women's multivitamin
9. Lorezepam 1mg (when needed)
10. Rizatriptan 10mg (when needed)

I feel like I'm just collecting diagnoses at this point. It's the Canadian medical system, and so it's like every doctor is disjointed from the other and it takes years to get specialists etc. I've moved a lot, so I usually had long distance family Dr's, but before I was like 20 or so I had no family doctor. So it was all walk in clinics. Then because I had family doctors that lived far from me (both were because I had moved away), I also had to use walk in doctors. And hospitals unfortunately.
I've suffered from really bad back pain (at first I was treated like I was after drugs, then was told it was muscle spasms, until finally got my scoliosis diagnosis). It's not bad enough for surgery I guess and they said it shouldn't cause problems, but it does. I also have fused vertebrae near the bottom of my spine? (Naturally). Like just two. It's been a long time since I was told this, sorry.
Over the years I've had:

1. migraines,
2. a pain in my ribcage/back area on the left side that feels like someone just put their fist there and left it there (it comes and goes),
3. UTIs,
4. severe fatigue (it's so life ruining)
5. overall body pain,
6. swelling of joints and joint pain,
7. nausea
8. gastro pains (I can't have gluten [only started after i had my kid at 23, but got much worse - im not celiac though, i had the scope], but almost everything I eat makes me feel sick, and now I have anxious reactions about food because.. yeah, I get really bloated and uncomfortable and so forth, even when its healthy)
9. depression (clearly),
10. rage, 11.panic attacks,
11. abdominal pain (unrelated to the food issue) so I've been in the hospital a bunch of times because they thought I had appendicitis or something (one time my appendix was like on the cusp of being considered to be removed I believe - but usually they were ovarian cysts that have ruptured),
12. Really cold fingers and toes
13. Feet will sometimes look purple. Ankles have been quite swollen as of late.
14. My hands can get kinda purpley looking
15. Sometimes half my face goes hot and the other doesnt? But more noticeably I'll have one ear go bright red and the other stays the same
16. I almost never have fevers. It would be super impressive to break 100.
17. Swollen lymph nodes.
18. very bad memory, but very good long term memory
19. Absolutely horrible and embarassing word recall issues. I'm not a dumb gal, I am great at writing and such, but you would never know when I speak, it's so bad.
20. Pre-canerous ovarian cells, got them removed with LOOP I think it's called - both follow ups after were clear
21. Shakey hands
22. Brain fog

And then lately I've been struggling with: 1. Light headed 2. Double vision sometimes 3. Impressively, even worse fatigue 4. Short of breath - I think that's related to COVID I had last month. I've gotten it twice and both times it kicked my ass, especially breathing wise 5. But the one that's been bothering me the most is the JERKING. At night it's the worst apparently, ill thrash and stuff... but it's gotten a lot worse lately. And then I would randomly get like a random leg jerk or something now and then, no big deal.
But within the last half month, it's gotten way progressively noticeable. I can sometimes feel it about to come on so I will sit down and yeah, it'll just happen. It happens to every part of my body, it's not picky. Fingers, legs, arms, whole body jerks. I've had a couple of auditory jerks (if that makes sense?) But only probably like three times total, and I think it'd usually when I have a full body spasm.
It's gotten to the point where my partner gets nervous about me driving long distances because he worries about me pressing too hard on the pedal or just, idk, moving the wrong way or something.
I went to the Dr recently and he ordered bloodwork. It was admittedly probably the best bloodwork I've ever had. I'm not anemic or have any deficiencies. The only thing that was off on my bloodwork was eGFR (88L) but was told that it was like on the cusp. Oh, and my specific gravity urine thing was <=1.005L. Went back to the walk in clinic and saw a different Dr. He said it was all fine and I was "probably a little dehydrated" (I drink more than recommended amount of water usually) and then did the knee slap like "alright see ya" and I was just stunned and was just kind of... ????
So I ask why I would be having these twitches and he paused and then asked if I have ever heard of tourettes and then said he was going to refer me to someone to discuss that possibility. I asked if adult onset tourettes is a thing and he said it was "rare, but can happen." I feel like that wouldn't be a first choice.. like if you hear hooves, think horses, not zebras kind of thing. Like he went straight to zebra.
I felt so defeated when I left. I hate being on 11 pills a day. I hate how tired I always am. I hate feeling like my life is passing me by or like I'm failing my daughter. I've had so many jobs because I can't keep a hold on them... either I get too depressed or get fired or just job hop for funsies, I don't know. I just feel like at this point I'm either misdiagnosed or something is missing I'm just... I don't feel like something is right. I know everyone thinks I'm a frequent flyer and my nurse sister straight up calls me a hypochondriac.
I'm just frustrated. I don't think I have "adult onset tourettes" but I feel like this isn't getting better and it's just getting worse. I'm not sure if any of my diagnoses are actually like... not actually separate, if that makes sense?
I don't know. Does anyone have any ideas or anything? Anything maybe I can suggest when I see my family dr next month? I just don't know what to do anymore about my health. I just know I'm in pain and I just want to live a more normal life.
Thanks for reading my novel.

About to turn 21, diagnosed with CP and I want to drink so badly. I know everyone here shares this sentiment but it sucks to not really have a choice anymore. Never been a heavy drinker either, just for fun outings with friends but now it’s pretty much over. I do use cannabis fortunately but still not a total replica. Also feeling really over the EPI. Still need to see a specialist and have some sort of plan to manage my symptoms which won’t be for months. Also rejected for genetic testing despite my case clearly warranting it. Healthcare on an organisational level sucks. On a positive, I am very grateful to the nurses, doctors and hospital/medical staff who are all doing their best and the ones who’ve helped me so far in even getting a diagnosis. Anyways, just your average wall-of-text vent. Have a good day everyone :)

I, 33F, woke up yesterday with UTI symptoms. Made a video visit appointment and the NP I met with suspected UTI and sent me to the clinic for a urine test. She said the initial results would come back right away and she didn't want to wait for the culture results to prescribe antibiotics because she didn't want me waiting another day in pain. Also said if it's not a UTI she'd let me know next steps so we can figure out what's going on. She said to message her if I needed anything else. Results came back within 10 minutes (at noon) and were abnormal for blood (large), red blood cells, and bacteria. I waited the rest of the afternoon and never heard from her and no comments on the results in mychart. I sent a message a little before clinic close asking if the results mean I need antibiotics because I was in a lot of pain and hoped I could pick up any necessary prescription that day like she said in the appt. Didn't hear anything back as of 1pm today. I called the clinic and explained and they said they'd send her a priority message and that l'd hear back from her or someone else by the end of the day. 10 minutes from when the clinic closes at 5pm I still hadn't heard anything. I called back and said they told me I could expect follow up and hadn't gotten any. They tried and tried to reach her and had me wait on hold. A different nurse came on and said that the NP was in my chart at that very moment attending to it. We hung up, the clinic closed a few minutes later, and I still haven't gotten any response or comments on my results. I feel so ignored and helpless. I honestly never push like this but everyone I spoke to kept telling me to expect something and then it wouldn't happen. I'm in acute pain and actively symptomatic and now it's the weekend. I have no idea what's going on or if I need treatment that I'm not getting. And I'll be charged for this visit even though l'm not getting a diagnosis or treatment. Any insight about the results and whether I should seek additional care over the weekend would be really helpful.