I recently watched a video by the YouTuber Ponderful wherein she linked to a diagnostic worksheet for EDS. The first category of that worksheet is the classic hypermobility check sheet, and I don't have any hypermobility at all. However, I have nearly all of the symptoms she describes in her anecdotes about her own personal struggle with her illness (which I'll list in a second) as well as some of the technical medical things listed on the EDS diagnostic sheet like bilateral papules on my heels; had no idea what those were called so thanks for that I guess lol
So I have autism, ADHD, pretty extensive stretchmarks on my upper arms, stomach, and back. I had a childhood history of pretty severe constipation and gastric weirdness though that has dissipated in my adulthood (however, I eat plant-based whole foods, so I don't know if my quite high-fiber diet may be masking gastric motility issues???). While I do not myself have a history of subluxations or dislocations, my mother dislocated her knees numerous times in adolescence. I have always had difficulty doing things like sitting in one place, not because of hyperactivity but because of somatic pain in my back or chest or progressive numbness in my extremities. I often wake up with arms that feel "dead" from having gone numb in my sleep.
I used to get horrible headaches that would come from nowhere and be nearly or completely debilitating for several days. I tracked that down to being tied to a combination of white flour and caffeine by doing an elimination diet. I've stopped eating that and am fine. I don't think it's a gluten sensitivity because I handle oats, whole wheat, etc. with no problems, it's just the processed stuff that sets me off. Caffeine more specifically gives me visual-field migraines where it looks like the edges of my vision are colorized version of old school CRT television screen static or "snow".
I currently work a desk job where I'm planning on a computer all day and it murders me to sit. I have bilateral IT band pain that has persisted for over a year. I have had the feeling of pressure on my chest (I've had EKGs and evaluations for asthma, etc. etc. and everything is normal) for at least 8 years now and only EXTENSIVE back-opening stretches in yoga help alleviate it.
I have very fair skin. My partner tells me I have very soft skin, and I have noticed my skin tends to peel or tear relatively easily, but I don't have the kind of scarring that is typical with EDS. Indeed, I have a nasty scar on my right knee from a bike accident when I was a child and it is the textbook definition of a hypertrophic scar.
I had asthma as a child, not sure if that is at all significant. I guess I technically still have it as I will develop asthmatic bronchitis if I get a severe chest cold, but I need an inhaler maybe twice a decade or so at this point in my life.
I just seem to be experiencing pronouncedly higher levels of feeling somatically aged (arthritis in both of my big toes, cracking and popping knees and ankles since I was like... 15...I sound like an octogenarian (no offense to any of you out there)). I'm trying to figure out what in the world could be the matter with me as I am at the same time capable of weightlifting and working out rigorously with no apparent sign of POTS or anything like that. Like I deadlift 315, bench press 245 (not breaking any records but my point is I'm able-bodied for the most part).
I'm currently 41, biologically male, and 6'4". Is there any other information that could be useful here? Is EDS one of those things like autism and ADHD that sometimes you just sort of have to self-diagnose? Is it possible to have it without the hypermobility? Or are there closely related connective tissue disorders that maybe might fit? I figure the medical community so frequently overlooks people with conditions like this where it's a constellations of symptoms that often get waived away by physicians as "just in your head" or "you're just not exercising enough" or what have you, so maybe other people have found rabbit holes to dive down to get more info. If you're out there and reading this, first of all, I'm so sorry for the lifetime of pain and gaslighting you've endured, and second of all, if you'd be willing to share some information, I would deeply appreciate the assistance, my beloved brothers, sisters, and gender-divergent siblings <3

Edit: Oh, I also developed varicose veins in my early 30's and while I don't have POTS, even when I was an NCAA athlete in college and in phenomenal physical shape, I would have an elevated heartrate and heavy breathing going up a flight or two of stairs. I've always found that weird. Also had really bad sleep apnea to the point of having to have surgery to correct it.
Oh! And now that I think of it, I have had a spider vein on my left calf just below the knee joint since I was like.....14.

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Does anyone know of any websites where we can practice diagnosing basic things from EKGs? My school is on our cardio unit, but I can't seem to find much practice aside from anki and a few random sheets my school gives us. I tried looking on google for any worksheets or online EKG quizzes but all I get is Mayo and Johns Hopkins explaining why EKGs are useful. TIA!!

Hi everyone, Today I took the NCLEX and it shut off in 85Q. I took about 1.5 hours. I got the pearson confirmation literally minutes after I walked out of the test center so I tried the PVT and got the good pop up. I checked again a few hours later and got the good pop up again just to be safe lol. Anxiously waiting for Monday to get my unofficial results.
Here's a recap about me and my process studying for anyone who is anxiously awaiting their test date like I was:
I graduated in May from a 4 year BSN program. I was traveling for most of the summer so I didn't start studying and prepping until mid-July. I used Archer and completed 25% of the Q Bank (About 1200Qs - traditional and NGN). I honestly was really off and on with my studying. I did about 10 days in July and then took a 2 week break from being burnt out and then 2 weeks before my exam I cracked down on the studying. The week of my exam I only reviewed my notes a little here and there. I got burnt out of doing practice Qs so I stopped once I felt like it I was scoring consistently well. I listened/ reviewed notes for all of Archer's lecture series. I felt good about my content knowledge but wanted to go over the little things they don't mention in nursing school - I thought Archer's lectures were good but I mainly read over the notes instead of listening to the long lectures. I mostly did readiness assessments (i took 9-scored very high on all of them). I also did 3 practice CATs on Archer - passed all of them. I also used Kaplan because my school made us buy it and we used it throughout nursing school. I had averaged around 68% on Kaplan qbank. I did 1 practice CAT, the readiness exam, and one priority exam (about 30 qsen of just priority) on top of the Kaplan questions I had to do for school. Kaplan questions were harder than Archer for me so my scores on Kaplan were lower (~65%) than Archer (my average was ~75%). I got a 67% on the Kaplan Readiness Test which online says correlated of a 98% chance of passing.
I also used SimpleNursing for his videos and worksheets. I read through Mark K notes (I tried listening to the lecturers but didn't feel like I was benefiting from listening to them). His last lecture was the most helpful. I listened to the HighYield pod cast as well in the weeks where I felt too lazy to do practice questions lol.
Honestly my exam was on easier topics than I thought. I came in expecting it to be tricky but I had mostly safety questions, priority, what would the nurse tell the patient or correct the patient on. The questions were vague but I just used by best judgment. I had no cardiac, EKG, renal, med math, diabetes, cushings/addison's, SIADH/DI respiratory "high yield" stuff that I prepped for. No peds at all. I had 1-2 maternity questions and like 3 psych/therapeutic communication questions. I had a few pharm questions (some on meds I never heard of, just guessed on those). Mostly questions on post op/PACU/safety after certain procedures very basic nursing stuff lol. I had few questions about cancer (mastectomy, AML). Case studies were simple and straight forward and about older adult patients. I had one case study on myasthenia gravis and another on lithium toxicity. I forget the other ones I had. Any lab values I needed were provided on the case studies and I didn't have any questions on labs outside of those. I'm probably forgetting some stuff but that was my experience.
I hope my story can be helpful to others because I was very anxious about my exam and would lurk on here a lot leading up to it. I feel like a huge weight has been lifted off my shoulders lol now that it's over. I definitely felt intimated reading on here how people do like all of the Qbank questions on Archer and U World but decided to just do what I thought would be the most helpful for me. Only you can know your study style.
Good luck everyone taking the exam in the near or distant future :)

Hello, all. I"m both a private pilot and an AME. Here are some suggestions for what people should and should not do to make a flight physical less unpleasant. Feel free to post any questions.

Don’ts
-Don’t drink coffee, Red Bull or any other energy drink.These increase blood pressure.
-Don’t exercise right before the exam. Exercise is great, but normal physiology causes blood pressure and pulse to increase and it takes a while for these to return to normal, depending upon one’s fitness. Exercise cabd cause dehydration which can make the urine protein test abnormal.
-Don’t go flying and especially flight instructing right before the exam. Stress, whether good or bad, will increase your blood pressure and heart rate.
-Don’t schedule the exam after flying all night long. This can increase your blood pressure. Being tired can also make reading small print harder, especially for those middle aged and older.
Do’s
-Do get plenty of sleep the night before.
-Do drink several glasses or bottles of water the morning of the exam. The is will help ensure the urine analysis is as normal as possible.
-Do bring your glasses. If your prescription is older than year, see an optometrist to make the vision test as easy as possible.
-Do take your normal medications. most importantly hypertension medications. For the sake of the exam it’s especially important that your blood pressure be controlled.
In summary: If it tastes good, feels good or is fun to do, wait until after the exam.
CACI’s
-Bring the required physician’s note and test results to satisfy the CACI.
CACI is an acronym for Conditions AME’s Can Issue. These are a group of common medical problems such as asthma and hypothyroidism for which an AME can issue a medical certificate without having to defer to the FAA. Each CACI has simple worksheet listing the criteria to satisfy each medical condition. All the the CACI information, as well as the AME guide, are available online. The biggest issue with the CACI”s is the required physician’s note for the condition. Pilots frequently forget the note or their doctor won’t give them the kind of note the FAA requires. The FAA wants more than a progress note generated by a typical office visit. Rather, there are specific items for each condition that the FAA wants specifically addressed. This is even more important for special issuances.
Special Issuances
-Do bring a copy of your ASI letter and the required reports to each exam.
A special issuance (Authorization for Special Issuance of a Medical Certificate) is a time limited medical certificate for certain medical conditions because of which an airman would no longer be legal to fly. Coronary arterial disease, cardiac arrhythmias, obstructive sleep apnea and cancer or common conditions that require a special issuance. The process for obtaining an initial ASI is prolonged and frustrating, often taking 6-12 months to obtain. It’s very easy become discouraged during the initial application. Once achieved it’s vital that airman follow each and every stipulation in the ASI letter and that they bring the letter to each flight physical.
What CFI’s should not do
CFI’s should be cautious about making suggestions regarding for what class of medical certificate an older, new student pilot should apply. There is almost no risk for anyone 34 or younger because no EKG is required, regardless of the class. However, an FAA flight physical is the worst place for anyone to have their first EKG because of the implications of an abnormality. Likewise, flight physicals should NOT be used as routine health screening exams.

PSA's
This post is now a Wiki entry here: https://www.reddit.com/uscg/wiki/direct_commission_officer_info/ This is where it is being updated with way more information and other useful resources to help you.
I've gone and created a FB Group since this post got like 10k views on reddit and not everyone uses this platform so come join us over on DCO (Direct Commission Officer) Mentorship and Development Coast Guard. These FB groups were a big part of getting help with your application and getting feedback when I was applying for AF OTS. The other part is that we represent a minority as DCO's in the commissioning percentage and our careers will have a different route then the majority of than the Academy and OTS grads.
Throwing this at the top since the Reddit app I'm using doesn't work with the chats function, please message me and we can chat that way, OR better yet, put your questions in the comments and I will try my best to answer them there and it will help anyone with the same question.
Recently maxed the bytes Reddit allows per post and had to split some of it into the comments to keep updating everything. Before the post's insights expired, this post had 16 shares and 10.9K views, so it's being seen by a lot of you. Share this with your friends and tell other people about this program.
I'm constantly updating this post with the goal of consolidating all my research, unfortunately, I'm updating different sections on the timeline so you have to reread the post to find the new stuff.
Read the comments.
I keep adding PSA's to the top so I've made it's own section.
Guys, talking with the OPM office and responding to a lot of messages I'm noticing a trend. Not trying to gatekeep this program in any way but you are expected to be able to find answers and follow directions. The OPM office made a comment that people are having trouble following directions to get their documents in on time. From my perspective, this your first test for being an officer or in military, can you follow directions?
I expect any of my troops to be able to research prior to coming to me for help. IF you can't find the answer, then ask for help. But from me, please don't waste the OPM's office time (they are super busy) asking questions that Google can answer for you. If Google can't answer it and you can't find the answer in the regs or this post or any of the resources I've put together, then please reach out, the OPM office is super helpful and I'm happy to help.
I keep learning new things about this program from talking to everyone who pm's and comments. You can apply for more then one program at the same time and be selected for multiple programs. DCSS AND MARGRAD for example or DCIO AND DCCO AND DCE, you could end up as a primary for both, a primary and alternate, all depends on what you can put in your application. I'm not sure if it's two applications so you can tailor your statement and resume to the program and two interviews or three but just another tool to put in your tool box.

My DCO Journey

The DCO Programs Start here if you don't know what this program is, the official USCG page is the best source of information out there.
I did a bunch of research and googling before applying and even now post-selection there is minimal information available about this process for someone outside the USCG. So I'm making this post for anyone in the future to follow. If anyone has gone through the process I'd love to hear your experiences to update this post.
This page has the majority of the front-facing information for DCE and the other direct commission routes. As far as I can tell the actual board dates aren't publicly available, only the recruiters know when the next DCE/DCA/DCCO/DCIO/DCL/DCPA opportunity will come around. However, talking with other applicants it sounds like all the DCO packages are boarded together at a Spring and Fall board, 1 May and 1 October, this is completely conjectured and you need to talk with a recruiter since you will have other deadlines to meet prior to the actual board date.
Eligibility With less than three dependents and less than 10 years of active duty service (someone on airforceots live chatted with the USCG and reported that this requirement is waiverable as of May of 2022, your mileage may vary) along with the appropriate degree OR course work, the USCG also seems to value relevant experience very highly. I would not have qualified without these since my undergrad is not an engineering degree. GPA 2.5 and up, do your research on the pages linked above or CIMs in the reference section.
However, the absolute gem of this program as a commissioning opportunity outside the Air Force is that you are not coded when applying by AFPC. Before the board results come out all you need is your Commanders concurrence to apply, this means you can apply for BOPs, get orders, PCS, or apply to an OTS board at the same time. Understand that if you reenlist, it probably won't look good if you turn around a month later and ask for a conditional separation from AFPC. But unlike applying for OTS, you are not locked with a code 05, in limbo for months while the board results get repeatedly delayed and they announce a 2% active duty selection rate. I always found this Google sheet helpful when determining if someone is competitive for Air Force OTS since it has a ton of data points, also don't discount the FB groups. If you've applied to an OTS board prior, I found this process and application to be much more straightforward than dealing with the Form 56 and AD LO app, plus wing level endorsement/CC bullets, competitive AFOQT scores, or listing your AFSC preferences in the right form. Also no AFOQT/TBAS testing or GRE scores for an MSC application.
Application Package I reached out to a Coast Guard recruiter after hearing about the program in August of 2021 and worked closely with them to complete the package which took about two weeks to get it ready for the recruiting deadline and to start scheduling the interviews by 1 September to meet the 1 October board.
Per the Officer Application Guide dated 2 Sept 2021: Contact your recruiter for the deadlines associated with the application programs of interest. It takes several months to complete all the steps in the application process. Applicants must connect with their recruiting office at least three months in advance of the application deadline to get started.
This came out while I was in the process of applying and I don't think it is a hard rule, but should indicate to you how much will have to go into this application.
Awards I was allowed to include up to three awards in the package, this is a loose term because I used my Eagle Scout certificate, BJJ Purple Belt with my competition medals, and the Honor Grad certificate from Airborne school combined with two letters of congratulations from Major Generals. Each of these I laid out, took a nice photo of, and then copied/pasted into a Word document and wrote a brief 250-word description of why I chose to highlight that achievement and what it meant to me, then saved as a PDF.
Letter of Recommendation For the letters of recommendation, I included one from my current supervisor (performance), an academic advisor (academic capability), and a retired O-5 I train Jiu-Jitsu with and have a personal connection to highlight future leadership potential. I included all my past performance reports, and records of military training (all those certificates the Air Force loves to give out) and drew the same/same comparison between my current Air Force AFSC (3E0X1 Electrical Systems) and the Coast Guard EM rate (Electricians Mate). Reading the descriptions of the MK, EM, DC, AET, IT, or ET rates it looks like a lot of Air Force technical AFSCs share some commonality with one of these rates, if you're wondering if your AFSC would qualify you for this program, I found this document from the States of Texas Auditors office for state jobs that list the equivalent AFSC or Rate conversion for maintenance hiring. Might help simplify the process or narrow down your search.
Ultimately it's about showing the board why you could fill an engineering position. For me, it was background as a contracting officer representative, infrastructure planning, along with technical knowledge and leadership experience as a holistic applicant. Having received a lot of feedback throughout the various iterations of my Resume, Biography, and Essay, it's best to showcase your abilities, not by listing achievements but by demonstrating how you have the academic ability to perform, the skills you possess (leadership/technical/discipline/ professionalism) and the real-world experience to back those skills up.
Resume/Biography/Essay I kept the same theme throughout the resume, biography, and essay that my AFSC was equivalent to the EM rate. Because the Coast Guard allows its NCOs with an Associates degree and 4 years of experience in the Rates I listed above to apply for this program and commission. I wanted to highlight that my experience and skills plus an Associate degree (CCAF in Mechanical and Electrical Technology) along with a Logistics and Supply Chain Management bachelor's degree would qualify me for a Direct Commission as an Engineer even though my undergrad was not an engineering degree.
Side note: I also heard of a SERE Specialist who was able to apply under the DCI (Direct Commission Intelligence) program by demonstrating how he had 4 years of Intel experience.
Hop over to resumes to build a nice 2-page document, this is the one that I used, I am not sure I'd use it again since it took a lot to format and turn into a 2-page product, so find the one that works best for you. The OJAK also has about 5 pages of resume feedback, follow this to the letter and make sure it is well-formatted and professional, this is where I included my military awards, professional associations (SAME, AFSA, AFA Etc), deployments, and scope of responsibilities. I highlighted the things I wanted by repeatedly capturing them in all three documents, however, in hindsight, I'd avoid too much double-tapping since it's making the documents copies of each other.
Medical I had to complete a commissioning physical with my PCM, this could also be done by a MEPS, I wouldn't recommend a civilian doctor outside the military just because of the forms they had to fill out. Someone PM'd me asking bout medical, I had to have a DD Form 2808 and 2807-1 filled out and stamped by my PCM, they completed an Audiogram and EKG, and ordered a full Lab blood work/screening panel/drug test and chest Xrays. Coast Guard Medical Manual, COMDTINST M6000.1 is the reference if you want to read more into it. After selection, they came back and asked for me to go see a cardiologist for an abnormal EKG, super annoying. Especially with the turnaround, they expected and that it was a requirement that could have been accomplished prior to the board meeting since they had already reviewed my medical records at that point. Everything went smooth, got a clean bill of health and the process went forward, in this situation, no news is good news.
Per the Officer Application Guide Dated 2 Sept 2021: Meeting accession height and weight standards and passing a commissioning physical are required as part of the eligibility screening process. Your recruiter will assist with coordinating the physical exam. If you are currently serving in the military, your physical must be completed with a military treatment facility (MTF). All civilian applicants will receive their physical through the local Military Entrance Processing Station (MEPS).
DD368 I had to get a DD368 signed by my commander which I dated to be good until Nov 2023. THIS ALMOST KILLED MY PACKAGE BECAUSE OF THE TIMELINE TO GET IT TURNED AROUND. It was also a hassle because the original Coast Guard recruiter I was working with wanted it approved by AFPC, a 6 to 8-week process up the Career Field Functional for concurrence. I switched recruiters about halfway through the process and the new recruiter agreed with me and my interpretation of the DD368 requirement per the recruiting commands SOP's. All that is required for the application to meet the board is the DD368 signed by your commander. It is a conditional separation, based on the USCG extending you an offer for a commission. Each service is different and has different processes for this form, understand the system, timelines, and requirements.
Interview Everyone I talked to said this is the single biggest factor in the application, my recruiter set up the interview and the board sent me an email to set a time in mid-September. I sat down with three current Coast Guard Officers in the engineering field. I won't go into much detail here but the questions are NOT drawn from a bank and do change based on the panel, mine were all they were generic, and the board did have my package before the interview. I did this in front of a webcam via Zoom in my blues, make sure everything works prior, my headphones decided to run out of battery halfway through 🤦. They rate out of 10, I hear 7's are the minimum of what you need, but you never get to see or know your scores.
Selection Two months go by after applying, it's now late January and I get a phone call notifying me of my selection as a primary candidate. They make lists of primary and alternates, if a primary can't fill the commission it goes to an alternate, you stay on the alternate list for a year but I don't know much about this beyond that. A week later the official notification (Looks like this comes out as a Coast Guard Recruiting Command All Publication (if your Air Force thinks like a PDSM on Mypers) unfortunately if you can't log onto the Coast Guard portal, you don't have access to it. However, someone did end up posting it to the Coast Guard Forum and my recruiter told me that I would get a letter in the mail and expect to commission in April and then go to DCO school in May. This is honestly super fast once the process gets going, it's a wild ride.
Per the Officer Job Application Guide dated 2 Sept 2021: DCO and SRDC results require the Secretary, Department of Homeland Security’s signature, and are released 2-3 months after the panel concludes.
I never actually received a letter in the mail, but I did receive an email with a document to sign to accept the commission as an LT JG/O-2, turns out the board can offer up to an O-3 based on experience, so a bachelor's plus a year of experience if I remember correctly = O-2. This was the first official piece of paperwork from the Coast Guard offering me the commission and contingent of a final medical/background and other pre-accession requirements. You are not actually hired once you are selected as a primary candidate, or accept the commission, so until you raise your right hand, don't get hurt or do anything stupid.
Another member reported that the first thing they asked for post selection was to complete the eqip and fingerprints.
Separation Once I had the official Coast Guard All Publication (I had my recruiter email it to me) and the letter offering me the commission, I routed both documents along with the DD368 to AFPC for a conditional separation with a window until Nov 2023, the MYPERS rep had me put it in as a miscellaneous entry on vMPF. It took about 8 weeks for approval with my functional manageAFPC. I had not established a firm DOS at this time, once the separation is approved you can set the date once you have a set date for commission based on the DCO school date.
Air Force Orders Mini rant ahead: I have multiple chat logs with Total Force Service Center Representatives and email chains with the MPF Assignments Office specifically asking about conditional separations and receiving orders, denying orders can be a career-ender and I have no intention of separating the Air Force if something goes wrong between being selected and hired into the Coast Guard. I was repeatedly told that once I had a pending conditional separation in the system, I would NOT be coded to receive orders, funny turns out that's not true. I am coming off a code 50 assignment and missed my BOP because of code 05 for an OTS board, so basically I'm a mandatory mover. I find out I'm a primary select, sign my acceptance letter, submit the DD368 + everything else through vMPF to my commander, then to the base separation Authority, and BAM get orders 🤦. Super frustrating to try and out process for separation and repeatedly have to explain it's not a PCS move. Eventually took my E-9 emailing the Career Field Functional and the MAJCOM functional to get the assignment removed. Then I had to contact the MPF to remove the checklist for PCS so I would stop getting emails for busting out processing suspense. Very frustrating for no reason because I wasn't ready to burn bridges by denying orders if a complication with the Coast Guard came back and made me ineligible for the commission. Definitely a stressful experience, 3/10 don't recommend it.
Commission Date The DCO program office reached out to set a commissioning date, I was able to defer to a later date to give myself time to pack and sell the house. I've heard some candidates are pushing this date back almost a year to allow them to finish enlistments or to meet other goals. I am currently on an extension until January 2023, so if the Air Force had denied my separation, I would have denied orders, separated in January then commissioned.
Assignment Around mid-March, the detailer reached out with a list of 32 assignments and asked me to rack and stack them. The jobs here are more important than the location because Coast Guard officers have primary and secondary specialties which factor into the career planning from day 1. I don't know much about this right now but choosing poorly might not give you access to the right quals or primary specialties, something the Coast Guard is looking for you to accomplish early on, talk with the detailer and understand how the assignment will impact your career.
Pro tip - If you know someone in the Coast Guard you might be able to get your hands on a copy of The Guide for Commissioned Officers in the U.S. Coast Guard (insert your job) Program, which might also be called a Purple Book, I know they have them for Operations Ashore, I've linked the 2015 version so there is probably more out there.
I found a list of the career guides, unfortunately, you need access to the Coast Guard portal to see them, but you could probably find older versions on google.
1 April I received an assignment in my top 5, however, I won't receive orders until I actually commission, this has impacted my ability to schedule with TMO. But I did route a memo from the OPM office to AFPC and get my separation orders with a DOS for 1 day prior to my commissioning date to begin Outprocessing and not have a break in service.
Separating and Outprocessing the Air Force I had to call the MPF to get my Outprocessing checklist loaded and they checked off a lot of the requirements since I wouldn't have a break in service or be leaving government employment. This means I didn't have to do a lot of things like talking with the National Guard, TAPS, VA, etc, this has really moved the process along. I used my orders to establish an expiration date when I got a new CAC to line up with my date of separation. I still have to do medical out-processing, but it seems like if you've had the audiology in the past year or dental, they will just sign it off. This section is still being updated.
Pre-commission Accession Paperwork Filling out the CG-2000 and 2025 forms, on my 2025 they had me use my current address to start entitlements based on my "PCSing" location. I was instructed to leave a lot of these sections blank since I am a new hire. I also didn't put down a Rate, just Rank. I needed to sign and collect a bunch of documents for my recruiter (marriage/birth/SSN/Voided check) to send to OPM office.
Prior to commissioning within 30 days, I have to get a body composition check for the OPM office, so make sure you are under that 39in waist or the screening criteria. Working to have this done with my local CG recruiting office.
About 12 Days out I still hadn't received my commissioning documents so I reached out to the OPM office and they sent them over within an hour.
Commission I'll update this section when I commission.
This is the document I used as a reference to write the script for my commissioning, I cut it down to like 3 pages, had the officer commissioning me help to tailor it with Coast Guard lingo and kept the Silver Dollar Salute, I bought mine from First Salute, Andy is awesome to work with and I would recommend hitting him up if you choose to do this. This is not required but I think it is a cool tradition to keep alive.
Note on types of Coast Guard commissions:
Per the Officer Job Application Guide dated 2 Sept 2021:
Temporary Regular: Commission granted for active duty Coast Guard applicants that are an E-5 or above with four or more years of active duty service, two of which must be in the Coast Guard. An officer with a Temporary Regular commission may rescind their commission at the end of their obligated service to either get out of the military or revert back to the enlisted/warrant rank they were prior to commissioning.
Reserve: All DCO and OCS applicants that do not meet the Temporary Regular requirements receive a Reserve commission. This means they will be hired into the Coast Guard Reserve on a 3-year Extended Active Duty contract. SRDC, DCL-SELRES, and DCPA-SELRES applicants will receive a Reserve commission and serve in a reserve capacity.
If the different types of commissioning still don't make sense, hopefully this article can explain it.
Below are some email copy/paste's from letters I received from the OPM office.
Your commissioning documents are included with this letter. You are being offered a Reserve commission in the grade of XXXX. In order to accept this commission, you must complete the attached Oath of Office Form (CG-9556) and Active Duty Agreement (ADA) on XXXX. Your Oath of Office is an affirmation that you are accepting a Reserve commission in the U.S. Coast Guard and establishes your date of rank as XXXX in the grade of XXXX. Completion of the ADA brings you on extended active duty and places you on the active duty promotion list (ADPL). If selected for promotion under a best-qualified criterion on the ADPL, you will be offered the opportunity to integrate and remain on active duty as a permanent regular officer. If you do not desire to integrate when offered, you will be released from active duty (RELAD) at the completion of your agreement. If you have not yet been offered integration by the end of your agreement and have less than 11 years total active service, you may apply for an active duty extension via the Reserve Officer Extension Board which convenes each year in January and July. If you have more than 11 years total active service at the end of your active duty agreement and wish to request an active duty extension, you may apply for an extension via a request memo to CG PSC (OPM-l). Your ADA will begin on XXXX.
Commission Ceremony You probably have a commission ceremony planned, however, if you do not have an event planned and are seeking ways to have your Oath administered, below is a list of CG approved officials who can officiate your Oath of Office.
Your Oath ceremony is totally up to you. We do not schedule it. You make your own arrangements. It can be large or small. It can be at a convention hall or in your living room. Your Swearing In can be in the presence of 100 people or it can be just you and the person administering the Oath. Its 100% up to you.
Our only requirement is that your Oath of Office is administered by one of the below approved officials.

Any Commissioned Officer (including Warrant Officers) -- from any Armed Forces {e.g., Army, Air Force, Navy, Marines, Coast Guard}; Active Duty, Reserve or Retired
U.S. Commissioner
Judge of a Court of Record
Clerk of a Court of Record
Notary Public
Justice of the Peace
Attorney General

Welcome Letter Two weeks before you commission I will send you your commissioning documents (with instructions). After you commission on xxx you will scan your signed documents and email them to me and the Accessions Team. After we receive your commissioning documents, the Accessions Team will hire you into the CG. After you are hired, your AO will create your Orders. Once we receive notification that your Orders have been created, the Accessions Team will finalize those Orders and send them to you authorizing you to start your travel to xxx. After arriving at your Unit you will processin/work until time for you to go to DCO school. While at xxx you will obtain: * ID card * Uniforms * Create a CG User Account workstation profile * Complete Personnel Data Questionnaire & Health/Physical Readiness Pre-Assessment * Obtain DCO Course TAD orders from Admin Office * Obtain a USCG web mail address * Set-up Direct Access user profile * and take care of other administrative items Following this email a representative from the Accessions Team will contact you to discuss your upcoming move and to answer any travel/accession related questions you may have. In the meantime, please contact your POC to introduce yourself and to discuss your new assignment.
Prior Service If you have ANY prior military service at all, please send us a copy of the following documents at your earliest convenience. We'll use these documents to submit a "Statement of Credible Service" (SOCS) to the Coast Guard's Pay & Personnel Center (PPC) once you start active duty. If you have prior service, expect to be underpaid until PPC completes your SOCS (SOCS approval is typically 4 - 6 weeks after your ADA starts). * All contracts (i.e., DD Form 4). * All Discharge Documents including DD-214's (preferably member copy, page 4) and NGB 22 and 23's for National Guard members. (NGB Documentsare the National Guard's version of the DD-214 and enlistment contracts) * All Oath's of Office (Officers) * For members who served in a Reserve Component and/or the National Guard (prior to entering us the US Coast Guard), we must have the Reserve Retirement Statements. * All National Guard NGB 22 and/or 23’s (NGB Documents are the National Guard’s version of the DD-214 and enlistment contracts). Copies should be available from the office of the State Adjutant General.
PCS Recently learned that myself and other prior service guys without a break in service make up a minority of the applicats, because of this I am not sure how everyone else is handling their PCS so don't take my frustration with this process to heart, your mileage may vary.
From the OPM: Your report date to your unit will be approximately two weeks prior to your DCO course start date unless an earlier report date has been approved by your new unit's command and OPM-1. You will receive an Active Duty Agreement (ADA) along with your commissioning documents. Some ADA's don't start until several days or weeks AFTER you've commissioned into the USCG unless you have no break in service. You should not move or start traveling to your new unit UNTIL your ADA starts. If you do, you may not receive GOVERNMENT reimbursement for your travel or HHGs shipment.
TMO Waiting for more information here but as far as the timeline for the move, I will be have an approximate 20 day window once I am hired to set up the move, get my household goods packed etc.
Finally got an answer about who is going to pay for my move. I'm electing to use my Air Force separation orders to request an alternate location for my final move. My orders are marked approving a final pcs to my place of enlistment, not the home of selection or home of record which kinda sucks. Luckily my place of enlistment is about 200 miles farther than my new duty location, so TMO will have to do a cost comparison worksheet but I am not expecting any excess expenses. I went with the Air Force orders since it's peak PCS season and everyone is trying to move, so getting movers even a month out will be a challenge. The movers have a week-long window to pick your stuff up and the final day can't be the same day as your departure date, so really you have to go back eight days, then add 45 days to that to give yourself a good window of when you should start this process. Probably going to try and find an android version of the Airtags for this trip to track our stuff. Anticipating about 2 weeks for delivery. I could have had the Coast Guard pay for my move since the weight allowance difference between E-6 and O-2 is 2,500 lbs (11000 vs 13500 w/dependents), and they will only pay up to the amount listed in your orders. But I'm under that and it would have to be a PPM since they can't schedule movers in time.
So I'll do a Partial-PPM, good news is the IRS upped the mileage reimbursement to $0.22 per mile increasing the MLAT. The rest of the entitlements are really based on your travel distance which dictates the number of travel days authorized which dictates the Per Diem and DLA.
DITY Move WHEN I was planning to move myself. Posted on the FB marketplace and got a ton of free boxes to pack up the house. CG needs a DD2278 from a local TMO office before you can do a DITY move yourself. The Partial-PPM still requires the DD2278 which you will get after creating your shipment in DPS and the TMO office will sign. Entitlements Go dig into the JTR but MLAT is 22¢ per mile AS OF 1 July 2022, Per Diem is the standard CONUS rate, derated for the first and last day, [DLA](defensetravel.dod.mil/site/DLA.cfm) is based on rank and dependents same thing with your weight allowance. You are taxed on profit at like 22%, travel days are rounded up but avg 350mi per day. TLA needs receipts but is capped at $290 for Lodging and M&IE. If you have trouble determining your TLE this is a helpful PDF and AirBnBs are authorized for 10 Days unless you are in an area where TLE has been extended. This Tread cover Non-A letters, I am assuming the YN at sector will issue this since most Coast Guard bases don't have lodging.
This is also a good copy/paste from that thread" JTR Chapter 5, Part A, Page 5A-26 July 2022

TLE is reimbursed at the locality per diem rate of the PDS, designated place, home of record, or initial technical school where the Service member occupies temporary lodging.

a. Government quarters must be used, if available, before commercial lodging and is subject to the rules outlined in Table 5-16. A Service member is not required to use Government quarters that are available in the vicinity of the designated place.*
Table 5-16 - TLE Lodging Requirements
IF... Government quarters are available at the old or new PDS and the Service member chooses to stay in other lodgings,
THEN... reimbursement is limited to the Government quarters cost or the locality lodging rate, whichever is lower.
IF... Government quarters are not available,
THEN... the Service member is required to obtain a non-availability confirmation number provided by the Service’s lodging reservation process to justify reimbursement for commercial or private lodging, a furnished or unfurnished apartment, house, mobile home, or recreational vehicle.
The Private Lodging is cool because I understand that to mean AirBnB, however, understand that TLE will only reimburse for the lodging, not the service and cleaning fees, the receipt has to be itemized. Take all this with Grain of salt because at some point they weren't authorized, see this response I linked from the JTR. Buckly has a great write-up
Per the JTR "Inter-service Transfer. When a member is: 1. Separated/relieved from active duty to continue on active duty in another Service, and 2. Transferred with no break in service from one Service to another under the authority of 10 USC 716 or any similar statutory provision, the member is authorized DLA when the household is relocated incident to an ordered PCS resulting from a change of service. NOTE: The service performed after such separation is a continuation of the prior period of service."
Reporting to Your Unit Don't know yet, received my sponsor's information from the OPM office about 2 months prior to reporting. You are allowed 10 days of TLE, recently some areas are allowing this to be extended because the housing market and house hunting days are command-dependent. I also received a form for a $400 allowance to turn into the admin section when I report to offset the cost of uniforms and items.
At my unit and its a lot to take in, show up with atleast a pair of TROPS and ODU's, know the ranks and terms of address. They will take care of you from there. I had to have my supervisor submit a CG Fix-it ticket for a username and password to then link my cac card to my account. When they linked my account they created my email.
DCO School Don't know yet. Here is the 2022 link to the pre-reporting instructions.
Questions and FAQ LEAVE My leave balance will transfer, I need to have the finance office place a comment in the remarks section of my DD214 with the remaining balance which I provide to the Coast Guard to credit me back, I'm going to make sure I have it under 60 days even though I'm doing this under the covid rules and the Coast Guard will allow its members to carry over 75 days for FY22. DFAS has a comment on the DD214 Worksheet that says this can never exceed 60 days and I don't wanna lose 15 days at the counter when I out process because some A1C is following a reg. OPM Guidance If you are TRANSFERING LEAVE from your previous service please have the DD214 annotated “Member to transfer XX leave days to Coast Guard” in the remarks section, OR for the Air Force members; provide the MEMO stating the number of leave days transferred.
They also provided a form 1089, said to delete the remarks and have the finance office put in the balance and sign. I'm doing both the Form 1089 and the remark in the DD214, because AFPC is the only ones who can edit or issue the final DD214 I dropped a copy of the signed 1089 off with FSS seperations and they attached it to a CMS case for AFPC to include ON the DD214.
RETIREMENT My high-3 retirement will also transfer or I will be offered the option to opt-in to the BRS. You need 10 year to retire as an officer. Here's a reference post from MilitaryFinance.
TSP My TSP might get paused, other interservice transfers report an issue here. The OPM office sent me a sheet showing me how to set up allocations so I'm assuming I'll just have to restart them. The Thrift Savings Plan group on FB is like 86k strong at this point, definitely recommend it.
Everyone is a Recruiter Just found out about this everyone is a recruiter initiative. If you've read this far and this post convinces you to apply to the DCO program, reach out and I'm happy to help with your application and maybe I'll get a ribbon out of it, just need the credit for recruiting you 👀.
I am running out of Bytes in this thread from all the updates and links, so I am copy/pasting the rest of this in the comments.

I was diagnosed with depression and anxiety 2 years ago and started Zoloft. It completely changed my depressive emotions. Since then, as I noticed all my depression disappear, different symptoms became more eye opening. I still am anxious a lot, and (after research) am showing signs of ADD/ADHD. I struggle to focus/concentrate, can’t hold conversations or eye contact, my tasks keep piling up, I pick at my face and nails 24/7, thoughts are constantly racing about the past and future, and am completely underperforming in school and work. I also mentioned I get irritated sometimes because I am overstimulated or overwhelmed (which I guess was taken too far). After my primary care wouldn’t listen to me about this, I thought I would try a psychiatrist. I had a new patient appointment and listed out everything. They gave me a ADHD/ADD screening/symptom “worksheet” to check off. After that, they basically said they’re confused if I have ADHD or a unknown mood disorder (even after I scored high on the worksheet). Then, they proceeded to prescribe me with the mood stabilizer Trileptal. No diagnosis, no further ADHD testing to rule it out, just a mood stabilizing prescription that I feel I don’t need because I don’t seem to have mood problems or mania. I also was asked to get an EKG test and lots of blood work.
My friend with a long history of bipolar says that they have never seen this before and also think I shouldn’t go back to this office because they question their judgment. I have already paid them money so part of me wants to ask for a reassessment in the treatment plan. I also don’t want to start taking this serious medication if I am not diagnosed. They are a professional, but it makes me uncomfortable. I’m not self diagnosing ADHD, I just feel that I show symptoms and even the doctor said so… so why didn’t they further discuss that instead or further discuss the potential mood disorder instead of a serious prescription? Anyone have experience or thoughts to share? Any opinion is appreciated.

Nothing Is Going to Happen to You During a Panic Attack, Not Even while Driving.
On the web, I see all this stuff about panic attacks being harmless. Sure, you'll feel like you're choking, and you'll feel like you're having a heart attack, and you'll feel like you're going to pass out, but you can just sit down, take some deep breaths, and you'll be fine.
Now imagine that all these things are happening to you as you're operating a moving vehicle speeding down the highway. And you're thinking, "Harmless? Uh, there's so much more at play here than just me and my body. I'm operating a moving vehicle and can run into other moving vehicles, people, and other obstacles. If I have a heart attack-- if I lose consciousness, that's it for me. I'm done."
But you're not going to lose consciousness.
"How can you be so sure? I mean, there are lives at stake here."
Well, don't trust me. Trust Edward J. Bourne. This information comes from The Anxiety & Phobia Workbook, by Edmund J. Bourne, Ph. D.
--
HEART ISSUES
"A panic attack cannot cause heart failure or cardiac arrest. ... According to Claire Weekes (1991), a healthy heart can beat two hundred beats per minute for days-- even weeks-- without sustaining any damage."
"During a true heart attack, the most common symptom is continuous pain and a pressured, even crushing sensation in the center of your chest. Racing or pounding of the heart may occur, but this is secondary to the pain. Moreover, the pain and pressure get worse upon exertion and may tend to diminish with rest. This is quite different than a panic attack, where racing and pounding may get worse if you stand still and lessen if you move around."
"In the case of heart disease, distinct abnormalities in heart rhythm show up on an electrocardiogram (EKG) reading. It has been demonstrated that during a panic attack there are no EKG abnormalities-- only rapid heartbeat. (If you want to gain additional reassurance, you may want to have your doctor perform an EKG.) In sum, there is simply no basis for the connection between heart attacks and panic. Panic attacks are not hazardous to your heart."
(More info on heart attacks from a different source.)
Yes, [heart attacks] can occur in rare cases, but the reality is that if you're younger than 40 and have no reason to believe you have any heart trouble, the likelihood of experiencing and surviving a heart attack is basically nothing. It is very, very rare for someone to have an undiagnosed heart condition that a doctor cannot find that they survive without issue. If there's no reason to think you could have a heart attack, you probably can't.
https://www.calmclinic.com/panic/panic-attack-or-heart-attack
CHOKING
"A panic attack will not cause you to stop breathing or suffocate. It is common during panic to feel your chest close down and your breathing become restricted. This might lead you to suddenly fear that you're going to suffocate. Under stress, your neck and chest muscles are tightening and reducing your respiratory capacity. Be assured that there is nothing wrong with your breathing passage or lungs, and that the tightening sensations will pass."
"Your brain has a built-in reflex mechanism that will eventually FORCE you to breathe if you're not getting enough oxygen. If you don't believe this, try holding your breath for up to a minute and observe what happens. At a certain point, you'll feel a strong reflex to take in more air. The same thing will happen in a panic attack if you're not getting enough oxygen. You'll automatically gasp and take a deep breath long before reaching the point where you could pass out from lack of oxygen."
PASSING OUT
"A panic attack cannot cause you to faint. The sensation of light-headedness you may feel with the onset of panic can evoke a fear of fainting. What is happening is that the blood circulation to your brain is slightly reduced, most likely because you are breathing more rapidly. This is not dangerous and can be relieved by breathing slowly and regularly from your abdomen, preferably through your nose."
"Let the feelings of light-headedness rise and subside without fighting them. Because your heart is pumping harder and actually increasing your circulation, you are very unlikely to faint."
ANAPHYLAXIS
(personal account from someone who had both panic attacks and anaphylaxis)
"My last episode of real anaphylaxis where my throat did close up had a very specific feeling like I had something lodged in it. I drank some cool water. Water went down fine. No blockages there! This was all in my mind."
"I would consider a physical blockage in my throat/mouth/palate (you literally cannot swallow), vomiting, cramps/diarreah, hives all over the body, and asthma/stridor (wheezing) undeniable proof and use the epipen."
http://peanutsurvival.com/index.php/2018/04/07/anaphylactic-shock-or-panic-attack/
Also, anaphylaxis is rarely caused by environmental allergens, and will happen within 3 to 30 minutes after ingesting something or being stung by an insect.
http://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-centeprofessionals/anaphylaxis-synopsis
HYPOGLYCEMIA
(I have hypoglycemia and also suffer from panic attacks.)
Hypoglycemia comes on fast, but you tend to get the early symptoms like dizziness, irritability, lightheadedness, hanger, and feel those for a few minutes before going to the more severe symptoms like feeling like you're going to pass out.
When I get hypoglycemia, my brain gets full of fog and clumsy and I have that "can't make thoughts" feeling. That doesn't happen when I have a panic attack. But if you've gotten a glucose tolerance test and it's ruled out hypoglycemia, you should be good.
https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685
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YOU CAN TURN THINGS AROUND
Now, these things in the above article talk about the worst-case scenario. You're not going to step right in the car and immediately feel like you're passing out right out of nowhere. No. Your anxiety takes a little time to build, and you can catch it and reverse it before you feel like you're about to lose control.
Yes. You can catch it and reverse it before you feel like it can impair your driving ability.
Anxiety comes in stages, as they describe in the Anxiety and Phobia Workbook.

Calmness
Passing twinge of anxiety, slightly nervous
Butterflies in stomach, muscle tension, nervous
Feeling uncomfortable but still in control, heart starting to beat faster, more rapid breathing, sweaty palms
Feeling "spacey," muscles right, beginning to wonder about maintaining control
Heart pounding, constricted breathing, spaciness or dizziness, compulsion to escape

6-10. Palpitations, difficulty breathing, feeling disoriented or detached, fear of losing control, compulsion to escape (6-10 in order of severity of these symptoms, from "I gotta get out of here" to "I'm going to die here. Right now.")
So as soon as you start feeling those symptoms, remind yourself that these symptoms are all caused by your rapid breathing, and if you can fix your breathing, you can reverse this.
--
PULLING OVER IS NOT GIVING IN OR GIVING UP
What most of us have is a driving phobia. It's a completely irrational fear generated by the subconscious mind. Though it's reasonable to be afraid of getting into a car accident, we take it to the extreme.
If you pull over when you start to feel anxiety symptoms, you are not giving up.
I repeat. If you pull over when you start to feel anxiety symptoms, you are not giving up. Pushing too hard can hurt more than it helps.
A few months ago I drove to a historic cemetery I'd been wanting to go to. It was way out of my comfort zone, and I did it! But when I think about my trip, I don't think about how I made it to the cemetery. I think about how much I suffered on the way there-- heart pounding, throat swelling up, feeling like I was about to pass out. My phobia still tells me I got there just by the skin of my teeth. That I survived out of sheer dumb luck. And now, every time I think about pushing myself a little farther out of my comfort zone, I worry about suffering that much again, and next time something even worse could happen to me.
I made myself push through my panic symptoms, because I thought I'd feel like a failure if I didn't. But I wish I'd pulled over a few times on the way so I could catch my breath, do some PMPATH, and continue on.
In the words of another writer from The Worry Games, "People pull over all the time…to discipline their kids, to clean up spills, find a lit cigarette, to take a quick nap, to look at a map. Yet for some reason those of us who need to calm down, feel like there is something wrong with us if we do it."
"I say go for it! Pull that car off to the side of the road, or into a nearby parking lot. Give yourself permission to make this choice without a sense of shame. Don’t worry about losing control and crashing your car while looking for a safe spot – the chances of that happening are minuscule! Adrenaline is there to help us stay focused, keep us aware of our surroundings, and stay safe. Take some deep breaths as you use that adrenaline to find a safe place to pull over, and then continue breathing and speaking to yourself in a slow, calm, reassuring manner."
https://theworrygames.com/2017/12/10-ways-to-stop-a-panic-attack-while-driving/
Your phobia is like a little kid. If you tell a kid there are no monsters under the bed, he won't believe you. You have to take him by the hand and show him that there are no monsters under the bed, over and over again.
The fact that you can pull over whenever, without feeling like a failure, will bring you so much comfort that eventually you will stop panicking and won't even need to pull over.
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CONTROLLING THE SYMPTOMS WITH BREATHING
So, pretty much, a lot of the symptoms you experience are fed by hyperventilation. In fact, many people hyperventilate, feel the symptoms, and label what they feel as panic!
"Physiological changes brought on by hyperventilation include increased alkalinity of nerve cells, which causes them to be more excitable. The result is that you feel nervous and jittery.
Decreased carbon dioxide in the blood, which can cause your heart to pump harder and faster as well as making lights seem brighter and sounds louder.
Increased constriction of blood vessels in your brain, which can cause feelings of dizziness, disorientation, and even a sense of unreality or separateness from your body."
"By slowing down your respiration and breathing from your abdomen, you can reverse two of the reactions associated with the fight-or-flight response-- increased respiratory rate and increased constriction of your chest wall muscles. After three or four minutes of slow, regular, abdominal breathing, you are likely to feel that you have slowed down a "runaway reaction" that was threatening to get out of control. "
"Slow, abdominal breathing, especially when done through your nose, can reduce symptoms of hyperventilation that may cause or aggravate a panic attack. The dizziness, disorientation, and tingly sensations associated with hyperventilation are produced by rapid, shallow, chest-level breathing. Three or four minutes of slow, abdominal breathing reverses this process and will eliminate hyperventilation systems."
The common recommendation is breathing into a paper bag, but further research on my end found that it was more of a placebo effect than anything else.
However, the book outlines an abdominal breathing exercise you can try.

Place your hand on your abdomen beneath your ribcage. (This is optional, but a good thing to add if you're pulled over.)
Breathe through your nose. Try to make your hand rise and fall when you breathe in and out through your diaphragm.
Inhale. Count to 5 as you slowly take air in.
Pause and hold your breath to a count of five.
Exhale slowly through your nose or mouth to a count of 5.
Breathe normally for a few breaths, then do it again.

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POSITIVE COPING STATEMENTS: IT'S NOT ALL WOO-WOO BULLSHIT
"Oh," you say. "You're going to tell me to think positive and these symptoms will go away? Ever heard of the placebo effect?"
Well, your negative thinking (whether your thoughts were overt or your subconscious mind was mulling over things internally) got you into this situation. And positive thinking will help you out.
You can pull over and breathe all you want. But if you're thinking "I'm panicking again!! I'm such a failure! I'm never going to be able to do this!!" your body will release more adrenaline, and you're not going to get anywhere.
I hate to break it to you, but whenever you're doing exposure therapy for a phobia, you're going to get anxiety, at least a little bit. It's only natural when you're doing something new. But when you're about to downhill ski for the first time or leaning in for a first kiss with the dreamboat you've been crushing on for weeks, you're more apt to label these heart-racing feelings "excitement." It's all in the context.
I found an Instagram post by Karen Salmansohn that described fear as "nature's caffeine." "Fear and excitement feel a lot the same. Each speeds up breathing and gives an adrenaline rush. ... Since I figured this out, I renamed "scary" situations as "exciting" situations. And when faced with one, I no longer view myself as "fearful," but "in extra energy mode" to keep moving forward.
https://www.instagram.com/p/Bj7UwyEHTHK/
So keep some mantras in your back pocket.
"This anxiety is a good sign: it means I'm already experiencing exposure."
"I need this anxiety-- I can't complete exposure to the situation without feeling it."
"If you're not getting nervous at least three times a week, you're not trying enough."
Also, screw all this "comparing yourself to others" crap. So what if the people you know drive all over. This isn't new to them, but this is new to you. I guarantee they weren't all cool and collected as gangly, awkward 15-year-olds in Driver's Ed. Anyone, when faced with something new, will be nervous. Your life just so happened to play out that your beginning is now.
---
RAGE AGAINST THE MACHINE (sorry, I couldn't help myself)
The book says that anger and anxiety are incompatible responses, and that it's impossible to experience both at the same time. Lucky for you, in your car, no one can hear you scream.
"If you can get angry at your anxiety the moment it arises, you may stop it from building any further. You can do this either verbally or physically." New conspiracy theory: road rage is just misplaced anxiety. But yeah, don't go too far and be a dick.
The book says things like punching pillows, throwing eggs into the bathtub, and chopping wood. I don't recommend any of those things while operating a moving vehicle. Also, hitting things with your car à la Icona Pop may be exhilarating in the moment, but it's also something I don't recommend.
Thankfully, if no one can hear you sing in the car, no one can hear you scream in the car. Have Disturbed albums on repeat.
This other writer from The Worry Games backs me up on this, saying that screaming was the original way to scare away "the predator." She said she can keep a calm face and let out a primal scream without anyone around being the wiser, but I'm not sure I'm at that point yet.
https://theworrygames.com/2017/12/10-ways-to-stop-a-panic-attack-while-driving/
--
ONLY YOU CAN PREVENT PANIC ATTACKS
Of course, there are things you can do to prevent panic attacks. They probably won't stop every panic attack from happening, but, seriously, if you ran a few miles earlier that day, your body's probably too tired to pump out masses of adrenaline.
These prevention tips are straight from the book:
-- Regularly practice deep relaxation. It doesn't have to be boring and/or mentally draining. (I like the hypnosis videos by Michael Sealey on YouTube, and Progressive Muscle Relaxation is also a great way to get your body to relax.)
https://www.youtube.com/watch?v=cQcd1LOmzas
https://www.youtube.com/watch?v=UHD4xNxgBec
https://www.youtube.com/watch?v=BpCioRUvpRk
-- A regular program of exercise. The more strenuous, the better. However, walking for 15 mins, 3 times a day, is doable. I have a friend who will watch movies while using an exercise bike. I will walk around my house in circles listening to some podcasts (there are some great ones on Spotify.)
-- Elimination of stimulants (esp. caffeine, sugar, and nicotine) from your diet. Also meth, coke, Adderall, Sudafed, what have you.
-- Learning to acknowledge and express your feelings. That shit will bottle up and start affecting you. For dealing with resentment and disappointment, google "The Work of Byron Katie" and do those worksheets (it's free.)
-- Adopting self-talk and "core beliefs" that promote a calmer and more accepting attitude toward life. Read some Eckhart Tolle.
tl;dr Panic attacks can't hurt you; the body has so many safeguards to make sure you don't die. You're not having a heart attack or passing out or any of that shit. You can reverse your panic before it gets to a certain point with certain breathing techniques, cognitive reframing, and maybe some good old fashioned rage-filled screaming.

Nothing Is Going to Happen to You During a Panic Attack, Not Even while Driving.
On the web, I see all this stuff about panic attacks being harmless. Sure, you'll feel like you're choking, and you'll feel like you're having a heart attack, and you'll feel like you're going to pass out, but you can just sit down, take some deep breaths, and you'll be fine.
Now imagine that all these things are happening to you as you're operating a moving vehicle speeding down the highway. And you're thinking, "Harmless? Uh, there's so much more at play here than just me and my body. I'm operating a moving vehicle and can run into other moving vehicles, people, and other obstacles. If I have a heart attack-- if I lose consciousness, that's it for me. I'm done."
But you're not going to lose consciousness.
"How can you be so sure? I mean, there are lives at stake here."
Well, don't trust me. Trust Edward J. Bourne. This information comes from The Anxiety & Phobia Workbook, by Edmund J. Bourne, Ph. D.
--
HEART ISSUES
"A panic attack cannot cause heart failure or cardiac arrest. ... According to Claire Weekes (1991), a healthy heart can beat two hundred beats per minute for days-- even weeks-- without sustaining any damage."
"During a true heart attack, the most common symptom is continuous pain and a pressured, even crushing sensation in the center of your chest. Racing or pounding of the heart may occur, but this is secondary to the pain. Moreover, the pain and pressure get worse upon exertion and may tend to diminish with rest. This is quite different than a panic attack, where racing and pounding may get worse if you stand still and lessen if you move around."
"In the case of heart disease, distinct abnormalities in heart rhythm show up on an electrocardiogram (EKG) reading. It has been demonstrated that during a panic attack there are no EKG abnormalities-- only rapid heartbeat. (If you want to gain additional reassurance, you may want to have your doctor perform an EKG.) In sum, there is simply no basis for the connection between heart attacks and panic. Panic attacks are not hazardous to your heart."
(More info on heart attacks from a different source.)
Yes, [heart attacks] can occur in rare cases, but the reality is that if you're younger than 40 and have no reason to believe you have any heart trouble, the likelihood of experiencing and surviving a heart attack is basically nothing. It is very, very rare for someone to have an undiagnosed heart condition that a doctor cannot find that they survive without issue. If there's no reason to think you could have a heart attack, you probably can't.
https://www.calmclinic.com/panic/panic-attack-or-heart-attack
CHOKING
"A panic attack will not cause you to stop breathing or suffocate. It is common during panic to feel your chest close down and your breathing become restricted. This might lead you to suddenly fear that you're going to suffocate. Under stress, your neck and chest muscles are tightening and reducing your respiratory capacity. Be assured that there is nothing wrong with your breathing passage or lungs, and that the tightening sensations will pass."
"Your brain has a built-in reflex mechanism that will eventually FORCE you to breathe if you're not getting enough oxygen. If you don't believe this, try holding your breath for up to a minute and observe what happens. At a certain point, you'll feel a strong reflex to take in more air. The same thing will happen in a panic attack if you're not getting enough oxygen. You'll automatically gasp and take a deep breath long before reaching the point where you could pass out from lack of oxygen."
PASSING OUT
"A panic attack cannot cause you to faint. The sensation of light-headedness you may feel with the onset of panic can evoke a fear of fainting. What is happening is that the blood circulation to your brain is slightly reduced, most likely because you are breathing more rapidly. This is not dangerous and can be relieved by breathing slowly and regularly from your abdomen, preferably through your nose."
"Let the feelings of light-headedness rise and subside without fighting them. Because your heart is pumping harder and actually increasing your circulation, you are very unlikely to faint."
ANAPHYLAXIS
(personal account from someone who had both panic attacks and anaphylaxis)
"My last episode of real anaphylaxis where my throat did close up had a very specific feeling like I had something lodged in it. I drank some cool water. Water went down fine. No blockages there! This was all in my mind."
"I would consider a physical blockage in my throat/mouth/palate (you literally cannot swallow), vomiting, cramps/diarreah, hives all over the body, and asthma/stridor (wheezing) undeniable proof and use the epipen."
http://peanutsurvival.com/index.php/2018/04/07/anaphylactic-shock-or-panic-attack/
Also, anaphylaxis is rarely caused by environmental allergens, and will happen within 3 to 30 minutes after ingesting something or being stung by an insect.
http://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-centeprofessionals/anaphylaxis-synopsis
HYPOGLYCEMIA
(I have hypoglycemia and also suffer from panic attacks.)
Hypoglycemia comes on fast, but you tend to get the early symptoms like dizziness, irritability, lightheadedness, hanger, and feel those for a few minutes before going to the more severe symptoms like feeling like you're going to pass out.
When I get hypoglycemia, my brain gets full of fog and clumsy and I have that "can't make thoughts" feeling. That doesn't happen when I have a panic attack. But if you've gotten a glucose tolerance test and it's ruled out hypoglycemia, you should be good.
https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685
---
YOU CAN TURN THINGS AROUND
Now, these things in the above article talk about the worst-case scenario. You're not going to step right in the car and immediately feel like you're passing out right out of nowhere. No. Your anxiety takes a little time to build, and you can catch it and reverse it before you feel like you're about to lose control.
Yes. You can catch it and reverse it before you feel like it can impair your driving ability.
Anxiety comes in stages, as they describe in the Anxiety and Phobia Workbook.

Calmness
Passing twinge of anxiety, slightly nervous
Butterflies in stomach, muscle tension, nervous
Feeling uncomfortable but still in control, heart starting to beat faster, more rapid breathing, sweaty palms
Feeling "spacey," muscles right, beginning to wonder about maintaining control
Heart pounding, constricted breathing, spaciness or dizziness, compulsion to escape

6-10. Palpitations, difficulty breathing, feeling disoriented or detached, fear of losing control, compulsion to escape (6-10 in order of severity of these symptoms, from "I gotta get out of here" to "I'm going to die here. Right now.")
So as soon as you start feeling those symptoms, remind yourself that these symptoms are all caused by your rapid breathing, and if you can fix your breathing, you can reverse this.
--
PULLING OVER IS NOT GIVING IN OR GIVING UP
What most of us have is a driving phobia. It's a completely irrational fear generated by the subconscious mind. Though it's reasonable to be afraid of getting into a car accident, we take it to the extreme.
If you pull over when you start to feel anxiety symptoms, you are not giving up.
I repeat. If you pull over when you start to feel anxiety symptoms, you are not giving up. Pushing too hard can hurt more than it helps.
A few months ago I drove to a historic cemetery I'd been wanting to go to. It was way out of my comfort zone, and I did it! But when I think about my trip, I don't think about how I made it to the cemetery. I think about how much I suffered on the way there-- heart pounding, throat swelling up, feeling like I was about to pass out. My phobia still tells me I got there just by the skin of my teeth. That I survived out of sheer dumb luck. And now, every time I think about pushing myself a little farther out of my comfort zone, I worry about suffering that much again, and next time something even worse could happen to me.
I made myself push through my panic symptoms, because I thought I'd feel like a failure if I didn't. But I wish I'd pulled over a few times on the way so I could catch my breath, do some PMPATH, and continue on.
In the words of another writer from The Worry Games, "People pull over all the time…to discipline their kids, to clean up spills, find a lit cigarette, to take a quick nap, to look at a map. Yet for some reason those of us who need to calm down, feel like there is something wrong with us if we do it."
"I say go for it! Pull that car off to the side of the road, or into a nearby parking lot. Give yourself permission to make this choice without a sense of shame. Don’t worry about losing control and crashing your car while looking for a safe spot – the chances of that happening are minuscule! Adrenaline is there to help us stay focused, keep us aware of our surroundings, and stay safe. Take some deep breaths as you use that adrenaline to find a safe place to pull over, and then continue breathing and speaking to yourself in a slow, calm, reassuring manner."
https://theworrygames.com/2017/12/10-ways-to-stop-a-panic-attack-while-driving/
Your phobia is like a little kid. If you tell a kid there are no monsters under the bed, he won't believe you. You have to take him by the hand and show him that there are no monsters under the bed, over and over again.
The fact that you can pull over whenever, without feeling like a failure, will bring you so much comfort that eventually you will stop panicking and won't even need to pull over.
----
CONTROLLING THE SYMPTOMS WITH BREATHING
So, pretty much, a lot of the symptoms you experience are fed by hyperventilation. In fact, many people hyperventilate, feel the symptoms, and label what they feel as panic!
"Physiological changes brought on by hyperventilation include increased alkalinity of nerve cells, which causes them to be more excitable. The result is that you feel nervous and jittery.
Decreased carbon dioxide in the blood, which can cause your heart to pump harder and faster as well as making lights seem brighter and sounds louder.
Increased constriction of blood vessels in your brain, which can cause feelings of dizziness, disorientation, and even a sense of unreality or separateness from your body."
"By slowing down your respiration and breathing from your abdomen, you can reverse two of the reactions associated with the fight-or-flight response-- increased respiratory rate and increased constriction of your chest wall muscles. After three or four minutes of slow, regular, abdominal breathing, you are likely to feel that you have slowed down a "runaway reaction" that was threatening to get out of control. "
"Slow, abdominal breathing, especially when done through your nose, can reduce symptoms of hyperventilation that may cause or aggravate a panic attack. The dizziness, disorientation, and tingly sensations associated with hyperventilation are produced by rapid, shallow, chest-level breathing. Three or four minutes of slow, abdominal breathing reverses this process and will eliminate hyperventilation systems."
The common recommendation is breathing into a paper bag, but further research on my end found that it was more of a placebo effect than anything else.
However, the book outlines an abdominal breathing exercise you can try.

Place your hand on your abdomen beneath your ribcage. (This is optional, but a good thing to add if you're pulled over.)
Breathe through your nose. Try to make your hand rise and fall when you breathe in and out through your diaphragm.
Inhale. Count to 5 as you slowly take air in.
Pause and hold your breath to a count of five.
Exhale slowly through your nose or mouth to a count of 5.
Breathe normally for a few breaths, then do it again.

----
POSITIVE COPING STATEMENTS: IT'S NOT ALL WOO-WOO BULLSHIT
"Oh," you say. "You're going to tell me to think positive and these symptoms will go away? Ever heard of the placebo effect?"
Well, your negative thinking (whether your thoughts were overt or your subconscious mind was mulling over things internally) got you into this situation. And positive thinking will help you out.
You can pull over and breathe all you want. But if you're thinking "I'm panicking again!! I'm such a failure! I'm never going to be able to do this!!" your body will release more adrenaline, and you're not going to get anywhere.
I hate to break it to you, but whenever you're doing exposure therapy for a phobia, you're going to get anxiety, at least a little bit. It's only natural when you're doing something new. But when you're about to downhill ski for the first time or leaning in for a first kiss with the dreamboat you've been crushing on for weeks, you're more apt to label these heart-racing feelings "excitement." It's all in the context.
I found an Instagram post by Karen Salmansohn that described fear as "nature's caffeine." "Fear and excitement feel a lot the same. Each speeds up breathing and gives an adrenaline rush. ... Since I figured this out, I renamed "scary" situations as "exciting" situations. And when faced with one, I no longer view myself as "fearful," but "in extra energy mode" to keep moving forward.
https://www.instagram.com/p/Bj7UwyEHTHK/
So keep some mantras in your back pocket.
"This anxiety is a good sign: it means I'm already experiencing exposure."
"I need this anxiety-- I can't complete exposure to the situation without feeling it."
"If you're not getting nervous at least three times a week, you're not trying enough."
Also, screw all this "comparing yourself to others" crap. So what if the people you know drive all over. This isn't new to them, but this is new to you. I guarantee they weren't all cool and collected as gangly, awkward 15-year-olds in Driver's Ed. Anyone, when faced with something new, will be nervous. Your life just so happened to play out that your beginning is now.
---
RAGE AGAINST THE MACHINE (sorry, I couldn't help myself)
The book says that anger and anxiety are incompatible responses, and that it's impossible to experience both at the same time. Lucky for you, in your car, no one can hear you scream.
"If you can get angry at your anxiety the moment it arises, you may stop it from building any further. You can do this either verbally or physically." New conspiracy theory: road rage is just misplaced anxiety. But yeah, don't go too far and be a dick.
The book says things like punching pillows, throwing eggs into the bathtub, and chopping wood. I don't recommend any of those things while operating a moving vehicle. Also, hitting things with your car à la Icona Pop may be exhilarating in the moment, but it's also something I don't recommend.
Thankfully, if no one can hear you sing in the car, no one can hear you scream in the car. Have Disturbed albums on repeat.
This other writer from The Worry Games backs me up on this, saying that screaming was the original way to scare away "the predator." She said she can keep a calm face and let out a primal scream without anyone around being the wiser, but I'm not sure I'm at that point yet.
https://theworrygames.com/2017/12/10-ways-to-stop-a-panic-attack-while-driving/
--
ONLY YOU CAN PREVENT PANIC ATTACKS
Of course, there are things you can do to prevent panic attacks. They probably won't stop every panic attack from happening, but, seriously, if you ran a few miles earlier that day, your body's probably too tired to pump out masses of adrenaline.
These prevention tips are straight from the book:
-- Regularly practice deep relaxation. It doesn't have to be boring and/or mentally draining. (I like the hypnosis videos by Michael Sealey on YouTube, and Progressive Muscle Relaxation is also a great way to get your body to relax.)
https://www.youtube.com/watch?v=cQcd1LOmzas
https://www.youtube.com/watch?v=UHD4xNxgBec
https://www.youtube.com/watch?v=BpCioRUvpRk
-- A regular program of exercise. The more strenuous, the better. However, walking for 15 mins, 3 times a day, is doable. I have a friend who will watch movies while using an exercise bike. I will walk around my house in circles listening to some podcasts (there are some great ones on Spotify.)
-- Elimination of stimulants (esp. caffeine, sugar, and nicotine) from your diet. Also meth, coke, Adderall, Sudafed, what have you.
-- Learning to acknowledge and express your feelings. That shit will bottle up and start affecting you. For dealing with resentment and disappointment, google "The Work of Byron Katie" and do those worksheets (it's free.)
-- Adopting self-talk and "core beliefs" that promote a calmer and more accepting attitude toward life. Read some Eckhart Tolle.
tl;dr Panic attacks can't hurt you; the body has so many safeguards to make sure you don't die. You're not having a heart attack or passing out or any of that shit. You can reverse your panic before it gets to a certain point with certain breathing techniques, cognitive reframing, and maybe some good old fashioned rage-filled screaming.

Looking for a little advice from some seasoned nurses! Summary at the bottom for those that don't want to read my life's woes! Thanks in advance.
So I'm in the middle of my orientation on a med surg floor with telemetry, about five weeks in. Overnight with a patient that's tachycardic to the 150's. Strict NPO. Hasn't been getting his usual PO heart meds for 2-3 days, finally catching up to him. Have tried various other methods over the course of the night (metoprolol IV x2 that worked for a hot second) Pt is not consistently tachy, he dances around going from 89-150, tending to hover at 130-140's. Leads, electrodes, and tele box changed. EKG took and examined. Apical and radial pulses taken. Pt is snoring and complains loudly every time I rush in to check on him. No complaints overwise. Doctors aware but not overly concerned at the moment. Taking their time over the course of my 12 hour nightshift.
Order tiny dose of Cardizem IV push. Take vitals beforehand, pt still tachy, but his BP has gotten lower. Was hypertensive, but the metoprolol fixed that. Still within safe parameters on the MAR popup. Slowly push cardizem.
Pt is still tachy an hour later at the change of shift. Giving report to the AM nurse and tell her about the night and what was given. Get told we can't push IV Cardizem, only an MD can. Confused, because we have a binder of IV pushes we can and cannot do, and the only thing it says for cardizem is that we can't titrate a drip on M/S. Cue my own heart dropping like I was the one that got the push of Cardizem. AM nurse makes a snarky comment about not being supervised and asks where my preceptor is. AM nurses grabs my preceptor and tells her this, but my preceptor breaks out the binder and says she's pushed it before, and that AM shift nurse is wrong. AM nurse tells me whatever, it's done, he's still alive, but be careful next time she really doesn't think it's allowed. Preceptor tells me I've done nothing wrong, have a good few days off, go home.
Anxiety has been eating at me since this occurred. I'm not sure who is right and who is wrong. I've read the do and don't worksheet of pushes a million times, and honestly, the cardizem one can be interpreted many ways. It doesn't specifically say "NO" to the push, but it doesn't say yes either. It only really says that we can't do a titrated drip.
I'm back on tomorrow and terrified I'm going to be called in by the supervisor. I want to be mentally prepared. I want to know if I made a mistake, and how grave of a mistake it could possibly be in terms of med errors. The patient was ordered the drug, the MD approved it and his vitals before I gave it, my preceptor allowed me to give it, and pharmacy verified it. I gave it according to guidelines, pushing it slowly. It was a small dose, and it didn't even affect the pt at all. Pt was on tele but not a bedside monitor as they only have them in the CCU.
I took what the new shift nurse said to me to heart, and realize that she made good points, regardless of if we are allowed to push the drug. I should have questioned the order further, should have double checked. I know Cardizem is a powerful drug, and things could have gone wrong. In a pinch, the data scopes we use for vitals can be turned into bedside monitors. I should have done that while pushing the meds in addition to using the telemetry monitors.
But on the other hand, I checked the reference book and had the go-ahead from the MD and my preceptor. Another nurse on the floor was also aware that I was giving the med, and had commented earlier when we discussing what could be done for the tachycardia that the MD might order Cardizem. What else could I have realistically done when two seasoned nurses were saying it was okay, and nothing in the binder told me not to give it?
TL;DR Gave a Cardizem IV push as ordered, not sure if I was actually allowed to do so as an M/S nurse. Freaking out and trying to prepare myself for the worst.

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