On Wednesday I was granted a PRO against my daughter’s father. I arranged for OFW to be used for communication regarding our daughter. I had to wait a few days for my fee waiver to be accepted, so I gave consent for him to communicate with me through text (WI restraining order). I have since gotten access to Family Wizard.
I’m seeking a bit of advice prior to my appointment at a family law clinic. I’ve been trying to arrange visits with my ex, he will not agree to these visits unless they are on his terms. I’m trying to gradually increase our daughter’s time away from me (primary caregiver) because she is just 13 months old and exclusively breastfed. She’s never slept without me there, still wakes to nurse, and hasn’t spent more than 4 hours from me at a time. I’ve communicated my willingness to work on night weaning and creating a small stash of milk. I have sent multiple sources on developmentally appropriate transitions for children her age going through parental separation. I want our daughter to be happy, healthy, well-adjusted. I don’t want to compromise her ability to form secure attachments or traumatize her by thrusting her into a completely new routine and keeping her from her trusted caregiver for extended periods of time before she is ready.
My ex is unwilling to visit her in the city we’ve always lived in. He tells me shorter visits aren’t fair. And when I expressed anxiety and doubt regarding overnights right out of the gate, he accused me of denying him time with his daughter. He has never helped with overnights since she’s been born, these have solely rested on me. He’s a heavy sleeper and if I ever needed anything I couldn’t get myself, it would require me shouting his name and shaking him. I’m very anxious she will be left to cry herself to sleep in his care, and CIO is something both us agreed we’d never do.
I’m sitting here reading and researching how to set her up for the best possible outcome. He’s concerned with the fact that he hates the city we’ve lived all her life and doesn’t “want to dick around for hours” with his daughter. He’d rather have her at his moms, nearly 40 minutes away. I don’t want to be seen as uncooperative, I just really love my daughter and want to do 50/50 in a way that honors and respects her development. What do I do? Am I being unreasonable and unfair?

TW: positive test, possible miscarriage, long post Disclaimer: I'm in the Netherlands, so our embryo's aren't tested and they don't do HCG blood tests in the hospital we go to. Question: has anybody else had this and how did it end?
On May 1st my boyfriend and I had our 6th transfer. So far, I've had one chemical pregnancy, four embryo's that didn't stick after their transfer and we lost two embryo's in thaw. Our 6th transfer (a FET) was a lovely 5B embryo.
I didn't have a lot of pregnancy symptoms during the two week wait and I always test 13 days post transfer, because this is when the hospital says to test and I know I'll drive myself insane if I do it earlier. So last Tuesday testday was finally here and to our huge surprise the test was positive within a second. My boyfriend was over the moon. I was mostly in some sort of shock and disbelieve. After all, last year we had multiple positive tests and at the 7 week ultrasound my uterus turned out to be empty: my body had already "cleaned up" the embryo. So I had a hard time trusting this test.
But after a nice call with one of the nurses I started to feel somewhat happy and hopeful. I was still super scared, but I also started to dream about a life with this baby. But this morning when I went to the bathroom, there was blood on my toilet paper. It started with some light pink/greyish blood, but when I went back to check 15 minutes later, it was bright red. I also had some very light cramping, but less than during a period. I called the hospital, where a doctor asked some questions and told me that it probably wasn't good news. She also said that there's no use in doing another test or HCG test now, because my body is still producing HCG so it will be positive anyway. We have to wait a full week before we test again. If it's negative we'll know it was definitely a miscarriage/biochemical.
The cramping stopped right after I called the hospital. The red bleeding turned into old blood that lasted rest of the day (it's 9PM here and there's still some old blood). I just don't know what to feel or do, my mind is all over the place and I'm so angry with my body. I'm terrified of losing our little embryo but at the same time I'm still somewhat hopeful that maybe it isn't over just yet. Has anybody else experienced this and how did it end for you?

I posted this in WomensHealth as well but would like more opinions. I (24F) am based in Ontario, Canada, and the wait for a gyno is killing me. I had spotting between my periods for the past 2-3 months, so my doctor ordered a blood test and ultrasound 11 days ago which showed a 5cm cyst in my right ovary, fluid, and maybe a uterine polyp. I am to book another ultrasound in 5 weeks.
She also did a pap smear and the results came back abnormal, she called me yesterday and told me to pay $100 for a HPV test, which I have yet to do, or wait a year for another pap.
I called 811 for a second opinion, and upon describing my severe consistent bloating and subsequent pain, waves of nausea, and everything else, the nurse told me to see a physician within 3-4h.
I found myself at the ER, where they did blood work and an ultrasound, ruling out pregnancy. The ultrasound results say I have a complicated cyst in my right ovary, 5.9x5.2x5cm. (Is a complicated ovarian cyst the same as complex?). As well as free fluid noted in the cul-de-sac.
The bloating is killing me and I can't imagine waiting 6 months for a gynecologist. I've been googling (I know, bad idea) my symptoms and now I'm scared of cancer. I also don't want kids and am quite firm on that, so I don't mind the risks of infertility associated with surgery. I wouldn't mind just having surgery to remove this cyst in order to check for canceendo/pcos and get rid of this bloating.
I've been thinking of traveling abroad to see a gynecologist sooner, as I have bad health anxiety and really want this bloating to just go away. I'm priviledged to WFH and blessed to even explore this option.

[FIRST][LAST]
Atlantis Commission
Officer Report - Lieutenant Colonel John Shepard
CLEARANCE LEVEL 5
Well this had definitely been a very interesting couple of hours. This dimension and its people had very odd opinions and ideas. Apparently the prey species of this dimension were all obligate cowards, whose instincts compelled them to be non-violent and run from threats. At least according to themselves. There were apparently some of them who were “predator diseased” as they called it, a disease which often resulted in increased violence, aggression, lack of empathy, and unheard like behavior. It sounded to me like some form of infectious psychopathy, but the venlil assured us it shouldn't affect us since we were predators, which didn’t really ease my fears, but hopefully it was something we could figure out when we got home if it ever became a problem.
Gotta love mandatory quarantine periods woo hoo!
As scary as this odd disease sounded, my main concern at the moment was to try and turn a professed coward into someone who could at the very least defend themselves.
I looked down to the table of gear ahead of me and then over to the mostly naked Venlil to my side, and then even farther to Tiel’c who thought It would be a good idea to help oversee Farva’s rapid fire training course. I fiddled with the bluetooth earpiece which was rigged up to one of our handhelds to run a translation program to speak directly with the captain. A big step up from our unknowingly one sided communications earlier.
I stepped on the other side of the plastic table and placed my hands down upon it and looked on at my new student..
“Welcome Captain Farva to our very impromptu accelerated course on Human arms armor and basic infantry tactics.” I said gesturing to the hodge podge gear we had managed to assemble for the good captain. “Are we ready to begin?”.
She flicked her ears, somewhat nervously by the looks.
“I’d take it that's a yes then?”
“Oh yes sorry”
“Alright then, well given that most of our crew is human and the only other alien struts around naked all the time, the only gear we have on hand is for humans, So you're going to be running size smalls and it's all going to fit all a bit big” I say as I toss her the tactical vest. ”Here try this on, we can try to tighten it up if it's a bit loose anywhere”. The captain wrestles with the buckles a bit, and Teal'c helps her tighten up some of the top straps, as the Venil’s shoulders weren't as broad as humans. Farva gave Teal’c an odd look, but seemed appreciative none the less.Once finished, she grasped the vest in her paws with interest. “This armor seems quite lightweight, which is nice, weight is often an issue that causes us to forgo armor, since heavy armor would hurt our running ability.” Farva remarks. “Also the sheer amount of pockets seems quite excessive, what do you need all these for?”
“Well for starters it's currently missing these '' I hand Farva one of the armor plates which she looks over. “That is a depleted Naquadria ceramic composite plate. It’s designed to stop bullet impacts and dissipate energy weapon blasts. It slots into that chest compartment in the front and back of your armor.”
“This isn't quite what Id imagine for the armor of your kind”
“What do you mean?” I asked.
“Well judging by your ships I would have imagined you would put more emphasis on defense Your predatory nature would make you less likely to run away from conflict allowing for more encompassing armor to cover more than just your chest, since you have less need to run.”
She would put it like that.
“Well there are a number of reasons for that, a lot to do with those excess pockets you mentioned. For starters you will not be carrying the same amount of gear that the standard infantry unit would normally be carrying, we are preparing you for a quick in and out op. Normally us expedition teams need to be deployed into unknown territory for extended periods of time, we need to carry everything we might need with us from food, bullets, weapons, to comms gear, sensors, repelling equipment etc. The weight from all that gear adds up fast; In order to stay sufficiently mobile and combat effective; we only carry enough armor to protect our vitals, head and torso, anything else can hopefully be patched up by a field medic.”
Tielc gave his piece as well. “It is important to know when to run both towards and aways from one's foes, not every battle can be won through strength alone, but by strategy and cunning. Being able to reposition oneself quickly is therefore highly advantageous”
Farva seemed to freeze at Teal'c's statement, not out of fear I think, she instead had a distant look in her eye. To snap her out of her slump I handed her a standard ballistic helmet.
Seeming to get the idea she looked at it oddly and tried it on. It confirmed to her head shape decently well but depressed her ears to either side of her head, kind of resembling what one might imagine a sad bunny rabbit to look like “I don't think this will be something I can bring with me” she said ” I can't use ear signals and this will muffle my hearing.”
“Why don’t you keep it on for the time being, I think any extra hearing protection might be useful considering what we are about to try next.” I hand Farva some ballistic ear protectors, slightly modified and somewhat ramshackle. “One of the corporals worked closely with Nurse Fila to get an idea for safe decibels levels for your kind, we were also able to get these earbuds molded to fit into your ear canal better”
Farva took them and slipped them in. “These are a bit uncomfortable, what do I need these for?”
“You'll need them for this” I say as I unsnap the clasps on the weapons case revealing its contents.
The content seems to capture Farva’s interest, getting a slight tail wave.
“Okay So this here is a p90, It carries a 50 round top loading magazine of teflon coated armor piercing ordnance. With a cyclical rate of fire of 900 rounds per minute.”
Farvas ears perk up at this. “This seems like an efficient design, I take it these are a flashlight and laser sight for accuracy?” She asked, pointing to the top of the weapon.
“Yes we also have holographic and acog optics which will help line up targets from farther away.” I look on as Farva picks up the weapon and inspects it, testing the weight as I note that it will weigh a fair bit more once loaded. But she doesn't seem to be struggling with the weight. I can't help but notice good firearm safety as well, she keeps her finger well off the trigger and takes care to keep her weapon pointed aways from anyone else.
“This seems like a solid design but I'm not sure how useful those weapon optics would be, as they are not designed for my side facing eyes”
“I'm sure our master at arms can figure something out, why don't we give it a test fire first tho, before we send it off to make adjustments.” I instruct her on how to load the weapon and turn the safety off. I warn her of the sound it makes. And while definitely taken aback by the recoil and sound at first, she quickly gets the hang of it, she has some respectable shot groupings in both single fire and in short bursts. And keeps the rounds reasonably centered while firing in full auto.
She did a whole lot better than I would have initially suspected given her performance in the hanger bay a day before.
“The rate of fire seems useful” Farva spoke “This would be useful for our soldiers, our accuracy falters when we are panicked, and the increased shot count should guarantee some hits based on volume of fire alone” she finished with a dejected expression.
She quickly places the weapon back in its case, as if it burned to touch.” I don't know if I should be armed for this mission, at least not with that weapon, I don't want to miss and hit one of you in the back!”
“What? Nonsense, you are a great shot, and this is just a precaution in case we get separated or flanked and need some covering fire. If our guys are doing their job right you shouldn't need to fire a single round anyways.”
Captain Farva’s breathing started to hasten, earlier I might have thought it was fear, but I was starting to get an idea of what the captain's issues were. I’ve seen this before.
“I.. I can’t be trusted with this responsibility, every time I am left in charge of something, every time people put their lives in my paws I ....”
“Farva, don’t you start with me now you hear.” I said sternly, swiftly capping off her inevitable spiral of self doubt.
“But.. no.. you don’t understand”
Stopping her again I spoke. “But nothing, what happened before on that ship, and back at that colony is in the past. I don’t know your whole situation, but from what I have gathered from the crew It was nothing good. You feel responsible and it's eating away at you, and frankly it doesn’t matter if that's true or not. Accidents happen, people make mistakes, and when that happens we need to learn, take those lessons to heart, and don't let it stop us from helping people in the present. If you let guilt, or fear of mistakes stop you, then bad guys have already won, all without having to have fired a shot”
Farva is quiet for a short time, I was hoping I got through to her, I'm not the best and pep talks and this certainly wasn’t your typical weapons demo, if only everyones could go as smoothly as Ronan’s.
Farva spoke quietly, arms pressed up against her chest, she looked so sad, defeated, and small. Well more than usual anyways. “We can't be strong like you humans, we are too emotional and when we are scared we run away or we lock up and...”
“And that is clearly not the case with you captain Farva” Teal’c finally reentered the conversation having heard enough. “You have shown courage with every action you have taken so far, your actions have saved the lives of many of your crew, every time you have been threatened you acted not just to protect yourself but others as well. You attempted to contend with beings many times your size without even thinking about it, all in the effort to protect others, and this is only in the time we have known you, this speaks nothing of your actions over the colony. You are a warrior of admirable courage Captain Farva, your self doubt is unearned.”
A single tear rolled down Farva’s eyes which she quickly wiped away. “That was very nice of you to say, but I'm not brave like you say, I was terrified out of my mind the whole time.”
Teal’c looked puzzled. “I did not call you brave, I said you were courageous.”
Farva shot back with the little venlil one up one down ear flick I had very quickly learned was confusion.” I'm confused you just said brave twice”
“Hmm it appears your language does not contain the word I am using, I apologize I am not used to speaking through a translator” Teal’c relented “ There are two words I am using admittedly in slightly different forms, bravery and courage. Bravery or to be brave is to lack fear, to not be afraid to begin with. Courage tho, Is a trait far more admirable. Courage is to be afraid, to have fear, to worry about one's own mortality and personal safety. It is to acknowledge risk, danger, to feel fear, but to act in spite of it.”
“Had I not met your kind before I would have thought predators don't feel fear.”
“Everyone fears feel Farva, It is how we overcome it that determines our worth as warriors”
Teal’c picks up the p90 and returns it to Farvas hands.
“Your people need a warrior Farva, a warrior who protects the innocent and guides the lost to safety. You have shown how collected you can be in the heat of battle, You have already proven your worth in our eyes Farva, now you must do the same in your own. The greatest enemy lies not without” Teal’c places his hand firmly on the venlil’s chest “But within”.
After Action Report - Venlil Colonial Defense Force
Subject : Chief Engineer Donu
I fiddled with my holopad, Its small surface area proving to be a consistent source of annoyance in my current endeavor. Gone was the large workspace afforded to me by my holotable back in my office. Instead I had to work with the scaled down portable holotablet I was just fortunate enough to have strapped to my person when I was beamed away from our last ship. I was stuck with its smaller keyboard and slower rendering speeds.
An annoyed smooth skin alien looked over my shoulder at my device, attached to it was a jury rigged fiber optic cable, slotted into a terran silicon to crystal patch cable, which would convert the electrical signals broadcasted by my tablet into a bandwidth that the terrans crystalline based computers; which they used for highly complex tasks like hyperdrive and transporter systems; could use, and then It was patched again in a even stranger connector to patch into the odd asgard computer stones.
All in all it looked like someone tried to plug a regular computer into some crystal construct like you would find in a fantasy holonovel, and again plugged that into a harchen heat rock sauna lounge. Finally branching out from this conglomeration was a simple copper based wire that connects to a computer terminal at which currently sat the late Doctor Rodney Mckay. A title upon initially hearing led me to believe he was a medical doctor, which led to a flurry of medical questions that he had absolutely no means of answering.
While this odd alien nomenclature was interesting, what intrigued me more was his actual area of expertise, theoretical astrophysics, as well as a number of other diverse specialties and fields. Not to mention not only was he a great scientist who had he been raised in the more civilized portion of this galaxy, would have knowledge and aptitude that would put him alongside some of Aafas greatest minds, but he was also an engineer without peer, at least in this galaxy. His interactions with general Samantha Carter hinted at her possibly being his match if not more. For a species that was supposed to glorify violence the decision to have a scientist be arguably the most senior member of what was by their admission a military vessel spoke to their commitment to knowledge and understanding, a very noble prey-like goal.
I looked warily at the lines of code at my screen, the asguard translation program had earlier scanned our ship and was able to parse written languages, but complex files, like images and 3d design schematics were harder to encode and decode from our perspective systems. As is stands we have 3 completely separate computer architectures, the asguard can talk to human computers and the venlil computers can talk to the asguard computers, It sounds like we would have everything we need to get a human C.A.D schematic into a venlil holotablet right? Wrong! And you're stupid for entertaining such a idiotic notion! Parsing text from raw binary is relatively straight forward, you're just looking for patterns, repeating bit combinations that might infer letters and then iterating them over millions of times looking for patterns, letters, words, and then with a bit of help from some undecoded analog audio transmission, spoken language. This is a far cry from actual procedural communication protocols,the ones that allow for file transfers, exactly what we needed if we were to get Rodney's redesigned part schematics into a format and medium that can be plugged into a suitable fabricator. Assuming one still exists, which I can reasonably assume it does.
Speaking of which, I have just made something of a breakthrough. For upon my screen appears a simple geometric hydrogen cube, we’re talking vertices, planes, material data, everything we need for a usable design file.
I let out an excited pent up yip, the culmination of hours of frustrating software integration work. Unfortunately I startled Rodney, who lets out a panicked gasp and clutches his chest pelts with one of his paws.
“Oh god…..” He gasps, pointing at me “Please.. don’t do that”
“Sorry!” I say a bit meekly. I slowly approach him so as to not make him unnecessarily uncomfortable and show him my work.
“I got the file exchange set up, all we need from you is to finish any modifications to your part, upload them to my holopad, and then we can print away at any class 3 or above fabricator we can scrounge up on Brayga colony.”
“Ok.. um.. got it, I'm almost done i’m just you know” He points a lone grasping appendage at his screen,”Running some simulations, making sure everything is up to spec.” keeping his response kurt. “Sorry for freaking out there.”
I nod my head in the human display of affirmation and return to my workstation to further bug check my work, to test potentially problematic edge cases for when he finishes. Tho Rodney's continued odd behavior intruded on my thoughts.
I should have felt empowered, being able to intimidate this ‘massive beast’, but I didn't. I didn't like being feared, his people have been nice to me, Rodney himself courteous to a fault and desperate for positive attention.
I thought I could expect predators to be fearless but that clearly wasn't the case, rodney was fearful, nervous, had I not known better I would say defective, and while it annoyed his crew, they didn't berate him for it, or attempt to assert dominance, they encouraged it even with placating words and tried to help him through it, they encouraged and supported him like a proper herd, even if sometimes it took the form of what the human would call a playful ribbing. I supposed I could help him as well.
I approached him again, careful to make my approach known to him, making sure to approach from within his limited field of vision. He looks up at me with a wide eyed glare, had I not known him I might have assumed it was hunger, but I did and knew it to be concern.
“Uh high Donu.. um whats up?”
“Why are you afraid of us rodney?”
“Wa-What, me afraid?” he gives out a panicked laugh ”uh no no, I'm not afraid, you know just a bit weirded out I'm just getting used to you all, it's not a fear thing it's a a…. Just getting used to new aliens thing, ask Hermirod we went through this whole song and dance right buddy”
Hermirod furrowed his brow and gave an irritated sigh from across the room.
I reached out to take Rodney by the paw.
His whole body flinched at my mere touch, I quickly withdrew my paw.
“Oh.. um.. I didn't…”
“Rodney! It's okay, your crew doesn’t seem to care when you show fear, and neither do I. Why are you afraid of us? You are almost twice our size and surely double our strength, most venlil would scream and run in terror at the mere sight of you. What's wrong?”
Rodney let out a sigh. “Oh its, we don't have to talk about this, I can deal with this, I deal with scary situations all the time, it's fine, I'll be fine.”
“Rodney, my people are a very emotional, empathic people, we are open with our feelings and with our fear, and the fear of the one can affect the herd, please let me help you. I don’t know what to expect from your society but I promise I wont judge you for your fear or emotions, I mean look at many of my crew mates, we are no one to judge”
Rodney shot back “You didn't seem to be so bothered”
“I’m too old to care, I was about to retire, hell I was about to die as far as I knew, Brayga colony was supposed to be a quiet place to lay back, work on some hobbies, plant a garden and pester the young men of my colony until I either dropped dead of boredom or got lucky” I joked.
That seemed to raise Rodney's mood somewhat. He sighed and seemingly relented.
“It’s… a dumb story, I don't even know why it affected me so much, I come from a place on earth called Canada, people don't usually believe me when I say I am from there, us Canadians are notoriously friendly and I guess I haven’t exactly filled that mold for a lot of my life, but hey I'm working on it, people like me, I have lots of friends back at Atlantis” He says the last sentence in a way as if it isn't me he's trying to convince.
“I'm sure you do, Rodney, You seem like quite the charming individual when you're not cowering!”
“Ha ha thanks, maybe you could come and visit sometime. Tell that to doctor Becket, really nice guy, smart man, he would love to meet you, he loves investigating new species. But back on topic, oh boy, so me and my sister Jeannie were on a family trip to rural Vancouver to visit my grandpa's farm, he kept a lot of goats, not for eating or anything, they were essentially pets that he would use for milk”
“Wait hold on? You drink milk from other animals! Do your females not produce enough milk for their young?”
“Oh um no, we just sort of drink it or ferment it into cheese!”
“Ferment? You mean spoil?
“Yeh”
I reeled from this plasma blast of a statement, I like any right minded venlil had a number of nightmares about being an arxur’s cattle before, especially when I first learned about those things in primary school, but never once had it crossed my mind that we could be used for something so weird. What the speh was I supposed to do with that information?
“Maybe you should get back on topic”
“Yeh sorry about that uh.. Anyways the momma goat had just had a litter of babies, and their real cute when their little, so late in the day when my grandpa was asleep we snuck out to the pens so we can play with the little baby goats, our grandpa told us not to but you now how kids are.”
At this I think back to a young Nyan, as I teach him the inner working of the hyperdrive, I tell him he’s not cleared yet to operate in this engine compartment alone, but I could tell from the occasional caught black hairs and dropped writing implements, there had been a number of curious unauthorized expeditions into its inner workings, he didn't really listen either.
“My sister as always was trying to be the voice of reason, wanting to take it slow. If I was paying attention I might have noticed the angry moma goat who didn’t appreciate the strange human messing with her children.”
The color seemed to drain from his face.
“I uh…” He began to stutter again ”I screamed, a lot, it was rather undignified, she ran right at me, thank god it wasn't a male goat, one with horns, I tired to run but I was hit in the back and knocked over and kicked real good in the head, like wake up in the vet clinic a quarter mile down the road kind of bad”
“This goat was a prey animal?”
“That would be what your kind focuses on”
“Oh sorry”
“Anyways It seems dumb but I have just never been good with animals since then, especially ones that look like you; no offense; I'm getting better but when I first saw you guys in the hangar bay, I was just that dumb kid again, getting in way over my head, scared for my life. I guess there is something to be said about childhood trauma. I really should be over this, I'm getting better with it I swear it’s just”
I take his paw again, he doesn't flinch this time.
“I'm a venlil, a prey animal, I know fear, I know what it is to live in fear, It rattles your brain, it turns your paws to wet grains. It takes great strength to overcome it, to push it aside just long enough to protect the herd. Your herd relies on you Rodney and you are doing a great job in spite of your fear, in spite of having to work with those you fear. You have achieved intellectual feats that rival the greatest minds of the federation and all that while struggling with a traumatic experience. Fear isn’t dumb and there is nothing wrong with you for feeling it.”
“Thank you” Rodney says “That means a lot, I won't be like forever I promise, I just need some time.”
“We will laugh about this someday,” I assured. “Nothing as big and intelligent as you should be afraid of anything”
“Are you calling me fat?” Rodney exclaimed with fake offense.
We both chuckled.
My kind words had resulted in a more upright posture, and a more cheerful demeanor from the human, almost like when I congratulated Nyan on his work, and it got me a look at that happy snarl of his, that I was starting to grow quite fond of.
After Action Report - Venlil Colonial Defense Force
Subject : Apprentice Engineer Nyan
Oh wow! I get to write a report for this mission! I never get to write reports, Donu says they're too boring, but there’s so many interesting things going on all the time. Sometimes I sneakily write my own! Just for fun of course, nobody sees them, which is probably for the best as I sometimes get excited and embellish them slightly. One of the reports I wrote was about the time Donu used nothing but a wad of electrical tape, a bottle of high grain venlil alcohol and a pocket knife to repair a venlil medical ship just in time to get out of the way of a big scary space predator, with glowing red eyes and a million tentacles!
Anyways Im not sure If im suppose to write these In present tense first person or past tense. I asked the captain and she said it's whatever so long as I make sure any pertinent dialogues are properly quoted(“”).
“Nobody usually reads these things anyways.” She said, but this one is surely going to be so exciting, who could look away!
I mean who's gonna scoff at a chance to read about friendly predators from another dimension! A dimension of friendly predators who give warm head scratches and hand out yummy strayu not strayu treats called donuts, that are somehow fluffier than strayu, and have a nice moisture to them. I asked for the recipe but Samantha said we wouldn't have the ingredients back on Venili prime to make them, and Teal'c said the recipe is an old family secret. Its weird predators would be so protective of their plant snacks.
There are so many weird things about these predators, they have nurturing instincts that make them find us cute. They stay perfectly balanced even if they don’t have tails, swinging their arms and body all over the place to keep upright like a lopsided gyroscope, it's pretty funny looking!
They also wear artificial pelts all the time, which I thought was weird, I thought maybe the ships temperature was set by the angry gray alien since he’s the only crew member beside the venlil who walks around naked all the time, maybe he had a fit when it was to warm, and the humans obliged him cause they were worried they would make him even angrier, and wore clothes to make up for the cold. I thought this made sense, a lot of their technology does seem to come from the Asguard, maybe he has more say in the goings on of the ship because of that. But apparently humans just like wearing pelts all the time. They feel uncomfortable without them and don’t like it if you try to remove them or look up their upper artificial pelts they call shirts.
The humans are so weird, I don’t even have to embellish my reports to make it more interesting. Like that time with the big tentacled space predator. That may sound real compared to this stuff but it Isn't, Ha! I bet you fell for it at first, hook line and sinker! Like the humans would say. I think I used that saying right, I'm not sure what it means, but Shepard brought it up when he was telling a story about the wraith.
The humans are so nice, instead of exterminating their predators they try to cure them! Their doctors are working to modify the wraith so they don't have to eat humans anymore, so they can be friendly predators too.
Anyways I should probably get to the actual report part of this report. Farva says I should start after I went off with Samantha to work on some special astrophysics equations she said I would be good at. I kind of wanted to go with Donu to help Rodney get the new parts they needed, or Farva to help rescue our people, but the humans and even the angry gray alien got really weird when Farva mentioned taking me on the mission. Samantha seemed to want me to help her really badly so I didn’t mind. Samantha says I have the most important part to our mission. She's teaching me about how humans communicate through subspace, and about stellar drift equations. We are working on what she calls the exit strategy.

I (24F) am based in Ontario, Canada, and the wait for a gyno is killing me. I had spotting between my periods for the past 2-3 months, so my doctor ordered a blood test and ultrasound 11 days ago which showed a 5cm cyst in my right ovary, fluid, and maybe a uterine polyp. I am to book another ultrasound in 5 weeks.
She also did a pap smear and the results came back abnormal, she called me yesterday and told me to pay $100 for a HPV test, which I have yet to do, or wait a year for another pap.
I called 811 for a second opinion, and upon describing my severe consistent bloating, waves of nausea, and everything else, the nurse told me to see a physician within 3-4h.
I found myself at the ER, where they did blood work and an ultrasound, ruling out pregnancy. The ultrasound results say I have a complicated cyst in my right ovary, 5.9x5.2x5cm. (Is a complicated ovarian cyst the same as complex?)
The bloating is killing me and I can't imagine waiting 6 months for a gynecologist. I've been googling (I know, bad idea) my symptoms and now I'm scared of cancer. I also don't want kids and am quite firm on that, so I don't mind the risks of infertility associated with surgery. I wouldn't mind just having surgery to remove this cyst in order to check for canceendo/pcos and get rid of this bloating.
I've been thinking of traveling abroad to see a gynecologist sooner, as I have bad health anxiety and really want this bloating to just go away. I'm priviledged to WFH and blessed to even explore this option.
I'd like to hear of other people's experiences to ground myself from all the doom that is the first page of Google. Do people have any experience seeing a gynecologist sooner rather than later in Ontario? Flying elsewhere in the world to recieve treatment? Having a large complicated ovarian cyst? Thank you.

I've been struggling feelings of anxiousness (that lead to feelings of depression) for years now. I don't even know how long excactly but my best guess is about 15 years. For me it's overly stressing about pretty much everything, overthinking stuff and always expecting the worst possible outcome. I've been trying to get help three times, once in high school and twice in university. No real results. I just recently decided to move from student healthcare to public healthcare, where I immidiately got an appointment to psychiatric nurse for a short term treatment period (3 sessions) based on self care. It should end on evaluation and if it's still there I should get more help.
Still even though this is the best shot I've been given in a long while I'm still pessimistic. I'm afraid the sessions just end and when fall comes around and I'm again hit by a flood of schoolwork I get that big spike in stress and anxiety again. I'm actually terrified of graduating and going to work only to be absolutely overwhelmed by stress and anxiety with no tools to deal with it. I'm not also just afraid for myself but for my family. I have a 10 month old son and wife and I don't want my issues be affecting on them. I think they already do and I hate myself for it.
There's also my really bad self esteem issues that I should be talking with somebody. I'm also not really comfortable about opening up about the darkest things there are and because of that I'm afraid they're going to be left without attention.
I just feel so stressed out and tired all the time. I just want help and I've sought out help but I still fear this is going to stick with me. It just feels like it's stuck within me.
Sorry for longposting, just needed to get it out

Sorry if this sounds selfish but this is really only a one time thing for a friend. I need someone to use there undetectable AI account to paraphrase this please.
IntroductionThe rise of fast food chains in the United States from 2000 to 2010 had an impact on both the culture and economy. This period saw an increase in obesity rates among Americans, which coincided with the growth of these eateries. In this essay we delve into the connection between the expansion of fast food franchises and the obesity epidemic examining factors that influence health. Through an analysis of data, health studies and relevant literature our goal is to provide an understanding of how consuming food has played a role in fueling obesity during this particular decade, in America.The Growth of Fast Food Chains
Between 2000 and 2010 there was a rise in the fast food industry. Popular chains such as McDonalds, Burger King and Subway expanded their reach by opening stores to meet the demand for budget friendly meals. Data from the U.S. Census Bureau shows that the number of fast food eateries increased by around 20% during this timeframe (U.S. Census Bureau, 2011). This expansion made fast food more convenient for a range of people, including kids and teenagers.
Obesity Trends in the U.S. (2000 2010)
The prevalence of obesity in America has been on a trajectory during the early years of the 21st century. According to the Centers for Disease Control and Prevention (CDC) the rate of obesity among adults rose from 30.5% in 2000 to 35.7% in 2010 (CDC, 2011). Similarly among children and teens aged between 2 and 19 years old obesity rates increased from 13.9% to 16.9% over that period. This continuous increase signals a concerning public health issue with impacts on illness rates, mortality rates and healthcare expenses.
The Impact of Fast Food, on Eating Habits
food is commonly known for its levels of calories, excessive saturated fats, sugars and sodium with little nutritional value. These aspects of food are closely associated with weight gain and obesity. Studies show that regular consumption of food is linked to consuming calories and maintaining poor eating habits (Bowman & Vineyard 2004). Research conducted by Pereira et al. (2005) revealed that individuals who ate food than twice a week were more likely to gain weight and develop insulin resistance compared to those who consumed it less frequently.
Influence of Socioeconomic Factors
The easy availability and affordability of food make it an attractive option for people with incomes. Fast food establishments are often concentrated in low income areas where residents have limited access to dining choices (Powell et al. 2007). This situation, referred to as "food deserts " , worsens the issue of obesity because disadvantaged groups tend to rely on food as their main source of nutrition.
Impact of Advertising and Promotion
The aggressive advertising tactics used by fast food companies also have a significant influence on eating behaviors particularly among young individuals, like children and teenagers.
Many businesses invest sums of money each year in marketing showcasing their products across platforms, like TV, the web and social networks. Kids are especially influenced by these strategies that highlight the appeal and ease of food reinforcing harmful dietary patterns early on.
The impact of obesity, on health is significant and variedObesity is a factor in chronic illnesses like type 2 diabetes, heart disease, stroke and certain cancers (Flegal et al., 2012). The rise in obesity rates has led to an increase in health issues putting a strain on the healthcare system. The financial implications of obesity are also noteworthy with studies indicating that medical costs linked to obesity made up around 10% of healthcare expenses in the United States during that time (Cawley & Meyerhoefer 2012).
Policies and public health effortsIn response to the escalating obesity crisis, different policies and public health efforts have been put into action at state and local levels. These initiatives aim to encourage eating habits through measures like food labeling requirements, restrictions on advertising foods to children and campaigns raising awareness about the risks of obesity (Koplan et al., 2007). Schools have been a point for intervention well, with endeavors to enhance the nutritional value of school meals and boost physical activity among students.ExamplesVarious real life examples and stories showcase the effectiveness of taking action to address the issue of obesity. For example, New York City put in place a set of strategies to combat obesity, such as displaying calorie information on menus and prohibiting trans fats in restaurant dishes. These initiatives led to improvements in people's eating habits and a slight decrease in obesity levels, within the community (Dumanovsky et al. 2011).ChallengesThe obesity epidemic still poses challenges despite the efforts to address it. Unhealthy eating habits deeply ingrained in society, the presence of the fast food industry and disparities in status all add layers of complexity to this issue. Moving forward it is crucial to focus on creating an environment that encourages choices for vulnerable communities. This entails advocating for policies that restrict the marketing of foods to children, enhancing access to options in low income areas and urging food companies to improve the health profile of their products.
Psychological marketingWhen it comes to food marketing companies go beyond advertising tactics by leveraging deep rooted psychological triggers that influence consumer behavior. Bright colors, catchy tunes and recognizable mascots are commonly used in food ads to build a memorable brand image. This technique is particularly effective with audiences like children and teenagers who're more susceptible and likely to develop lasting brand loyalties. Research indicates that exposure to these advertisements can lead children to prefer calorie, nutrient foods ultimately impacting their dietary decisions and contributing to weight gain (Boyland & Halford 2013).The impact of portion sizes
One overlooked but significant factor contributing to the obesity crisis is the increasing sizes of portions served by food chains. Over time portion sizes have substantially grown, with meals exceeding the recommended calorie intake for a single meal. Young and Nestles (2002) study reveals that fast food item portions have expanded over the years with some items now more than double their size. This phenomenon of "portion distortion" results in calorie consumption as individuals tend to eat when faced with larger servings often underestimating the actual caloric content.
Changes in lifestyle and time constraints
The contemporary way of life characterized by schedules and time limitations has also played a role in the heightened dependence on fast food. With an increase in dual income households and longer work hours many people find themselves lacking the time to cook meals. Fast food emerges as a solution offering cost effective options that align with busy routines. Nonetheless this convenience comes at a price as frequent consumption of food is linked to dietary patterns and increased calorie intake contributing to the surge in obesity rates (Smith, Ng & Popkin 2013).Another significant measure involves restricting the promotion of foods to children. By reducing kids exposure to food ads policymakers aim to lessen the impact of marketing on their eating habits. Some cities have also imposed taxes on beverages and unhealthy foods in an effort to discourage consumption through penalties. While the effectiveness of these strategies may vary they mark progress in combating the obesity crisis.
Approaches Rooted in Communities
Community based strategies for addressing obesity highlight the importance of initiatives and grassroots movements. Programs that concentrate on enhancing access to foods encouraging activity and educating community members about healthy eating have shown positive outcomes. For example community gardens and farmers markets can offer produce to residents living in areas with access to healthy food options promoting better dietary choices. Schools and community centers can also play a role by providing nutrition education and physical activity programs.
The Impact of Technology
Technology has increasingly become an asset in the battle against obesity. Mobile applications and wearable gadgets enable individuals to monitor their calorie intake and exercise levels offering feedback and motivating lifestyle choices.
Furthermore social networking sites can play a role, in advocating for public health initiatives and sharing details on diet and wellness. Although technology isn't a solution to the issue of obesity it provides avenues to involve people and groups in embracing healthier habits (Stephens & Allen 2013).
Future Directions and Recommendations
The approach to tackling obesity needs to be multi-faceted and should involve collaboration between government departments, health workers, local communities, as well as the food industry. In future, there is need for more efforts in creating an atmosphere that supports healthier selections particularly among the disadvantaged groups. This means that one should continue to campaign for policies aimed at reducing children’s exposure to unhealthy food advertisements, improving availability of healthy foods in deprived neighborhoods and encouraging manufacturers in the food sector to change their products into a healthier version.
Further still public health campaigns will try and focus on having balanced diets regularly done exercises. Schools and offices can succeed by developing well-structured meals alongside opportunities for exercising. More research is also needed to understand why some people are poor eaters or overweight than others.
Policy Proposals
To further combat the menace of overweight, policy makers should think about enacting a variety of evidence-based strategies. Some of them could be: Sugar-Sweetened Beverage Taxes: Taxes on sugary drinks can decrease consumption and raise funds for public health projects. Zoning Regulations: By controlling the number of fast food restaurants in given areas, intake will subside and encourage establishment of grocery stores among other healthier alternatives.Menu Labeling Laws: This makes sure that restaurants indicate calorie counts as well as other nutritional information to assist customers in making informed choices. School Nutrition Standards: Schools meals and snacks in the course of learning ought to meet recommended nutrition levels so that students are eating healthy. Addressing Behavioral FactorsBehavioral interventions also play a significant role in dealing with obesity. Cognitive-behavioral therapy (CBT) and other psychological approaches aid individuals to develop better eating habits and deal with triggers involved in overeating. Programs addressing weight control which incorporate behavior change counseling together with diet and exercise components show promise towards helping individuals achieve successful long term weight loss.Long-Term Commitment and Sustainable Change
Society must collectively make a commitment that will last over a long period to reduce obesity rates. The approach should be ongoing and flexible enough to accommodate changing circumstances and new information. For this change to be lasting, there must be continuous investment in public health infrastructure, research, and education. Therefore, significant strides can be achieved in reducing obesity rates by nurturing a culture that appreciates wellness.
Cultural Shifts and Public Perception
In addressing the obesity epidemic another critical factor is shifting public opinion as well as cultural norms with regards to food and health. The acceptance of fast food and oversize portions as normative has been one of the major drivers towards unhealthy eating habits over the past few decades. This would involve public health campaigns focused on what constitutes healthy balanced meals and promoting on good home cooked fresh meal benefits instead. To change public perception cooking classes nutrition workshops media campaign advertising preparation advantages of healthy meals at home for instance.
Strengthening Health Care Interventions
Routine screenings, counseling and support for weight management by health care providers are crucial in handling obesity. Obesity prevention and treatment should be integrated into primary care to ensure consistency and comprehensiveness in people’s health. Personalized advice can be availed by the healthcare practitioners and also set realistic targets as well as referring patients to dietitians or structured weight loss programs.
Advancing Research and Use of Proven Practices
To better understand the intricate contributors to obesity and curate effective interventions, it is important to sustain research. Longitudinal studies that follow diet patterns, activity levels, and disease outcomes offer useful information on how to prevent or reduce obesity. By exploring behavioral, environmental and genetic factors that affect obesity, this will enable us to make interventions that are specific for different populations and situations as well.
Conclusion
The period between 2000 and 2010 registered a sharp increase of obesity rates that is closely linked to the spread of fast food outlets across America. This public health menace can only be fought with multidimensional approaches that will change public attitude, improve education, enhance corporate accountability and support inclusive research plus health care interventions. By creating an environment where good health is appreciated through provision of necessary resources and support, we can achieve significant milestones in curbing cases of obesity within our population as well as overall improvement in their welfare.
Citations:
Boyland, E.J. & Halford, J.C.G., 2013. Television advertising and branding. Effects on eating behavior and food preferences in children. **Appetite**, 62, pp.236-241.
Brownell, K.D. & Frieden, T.R., 2009. Ounces of prevention—the public policy case for taxes on sugared beverages. **New England Journal of Medicine**, 360(18), pp.1805-1808.
Drewnowski, A. & Specter, S.E., 2004. Poverty and obesity: the role of energy density and energy costs. **American Journal of Clinical Nutrition**, 79(1), pp.6-16.
Krieger, J.W., Chan, N.L., Saelens, B.E., Ta, M.L., Solet, D. & Fleming, D.W., 2013. Menu labeling regulations and calories purchased at chain restaurants. **American Journal of Preventive Medicine**, 44(6), pp.595-604.
Ogden, C.L., Carroll, M.D., Kit, B.K. & Flegal, K.M., 2014. Prevalence of childhood and adult obesity in the United States, 2011-2012. **JAMA**, 311(8), pp.806-814.
Smith, L.P., Ng, S.W. & Popkin, B.M., 2013. Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from 1965-1966 to 2007-2008. **Nutrition Journal**, 12(1), p.45.
Stephens, J. & Allen, J., 2013. Mobile phone interventions to increase physical activity and reduce weight: a systematic review. **Journal of Cardiovascular Nursing**, 28(4), pp.320-329.
Story, M., Kaphingst, K.M., Robinson-O'Brien, R. & Glanz, K., 2008. Creating healthy food and eating environments: policy and environmental approaches. **Annual Review of Public Health**, 29, pp.253-272.
Walker, R.E., Keane, C.R. & Burke, J.G., 2010. Disparities and access to healthy food in the United States: A review of food deserts literature. **Health & Place**, 16(5), pp.876-884.
Young, L.R. & Nestle, M., 2002. The contribution of expanding portion sizes to the US obesity epidemic. **American Journal of Public Health**, 92(2), pp.246-249.
Fulkerson, J.A., Story, M., Neumark-Sztainer, D. & Rydell, S., 2008. Family meals: Perceptions of benefits and challenges among parents of 8-to 10-year-old children. **Journal of the American Dietetic Association**, 108(4), pp.706-709.
Huang, T.T.K., Drewnowski, A., Kumanyika, S.K. & Glass, T.A., 2009. A systems-oriented multilevel framework for addressing obesity in the 21st century. **Preventing Chronic Disease**, 6(3), A82.
Kumanyika, S.K., 2008. Environmental influences on childhood obesity: Ethnic and cultural influences in context. **Physician and Sportsmedicine**, 36(1), pp.45-51.
Larson, N.I., Story, M.T. & Nelson, M.C., 2009. Neighborhood environments: Disparities in access to healthy foods in the US. **American Journal of Preventive Medicine**, 36(1), pp.74-81.
Ludwig, D.S. & Pollack, H.A., 2009. Obesity and the economy: from crisis to opportunity. **JAMA**, 301(5), pp.533-535.
Powell, L.M., Chaloupka, F.J. & Bao, Y., 2007. The availability of fast-food and full-service restaurants in the United States: associations with neighborhood characteristics. **American Journal of Preventive Medicine**, 33(4), pp.S240-S245.
Sallis, J.F., Floyd, M.F., Rodríguez, D.A. & Saelens, B.E., 2012. Role of built environments in physical activity, obesity, and cardiovascular disease. **Circulation**, 125(5), pp.729-737.

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.

Where to begin… essentially our mother reminds us of both a child and a Karen if that makes any sense? Here are some tidbits of the past 20 years.

• repeatedly makes threats of suicide when something doesn’t go her way or angers her, starting when I was the age of 8
• one time I asked her a question on my science homework (she didn’t know the answer and also was annoyed at me asking), and she hit me on the head and I was so dizzy that I fell into the stove, which was on at the time. brought it up many years later and she laughed nervously asking if i was completely sure if that happened
• kicked my sister when she was 4, when she was asking her a quick way to distinguish left from right, because she was talking on the phone with her friend and didn’t want to be interrupted. also threw her stuffed animals across the room
• when something minor happened (we were about to be late for the bus and weren’t moving fast enough for her in elementary school), she pretended to have a mental breakdown/panic attack and faint on the floor. when I told her I was about to call 911 (I was scared out of my mind), she promptly got back up and acted like nothing ever happened
• when I told her I was severely depressed and had an ED, she complained that she didn’t know what other people in our community would think of her, and also pretended to stop breathing and fell on the floor AGAIN
• my sister had a knee injury from cross country, and when she asked our mom when the next appointment was, she blew up at her, started swerving the car purposely and driving recklessly, had a full on mental breakdown, honked the horn for long periods of time in the garage several times, pretended how to forget to open the garage door, and called her the spawn of Satan
• refused to talk to me ever again after I told her that I couldn’t do orchestra anymore because I was prioritizing adding more classes focused on my potential major, she proceeded to ignore me and deny my existence for almost a week. the only reason she started talking to me again was because there were two suicides at our school in one week. similar thing happened to my sister last year
• extremely clingy, needy, and possessive. i was instructed to send her good morning and good night texts everyday. i also had to always have my location on as an almost 21 year old. when i didn’t respond to good morning quickly enough once (was talking a shower after i slept in and didn’t see her text), i came back to dozens of calls and texts asking me what happened, and she was about to call the police to do a house check. extremely annoyed, i asked her to stop with the good mornings and good nights, and she reluctantly said ok and sent them anyway and called when i didn’t respond. also if i don’t send emojis in response to her when she does or mirror her exclamation points, she says that i’m mad at her
• when my sister cut her own bangs and it didn’t turn out the way she had hoped, my mom chased her with scissors and locked her in the garage until i had to beg her to get her out
• my mom is overweight, while my sister and i have always been slim/skinny, and it seems like this bothers her though she doesn’t explicitly say it. when i went on a recomp journey to gain more muscle and lose fat, she constantly criticized my mela because i refused to eat the food she cooked (she dumps oil on it and i have told her several times to stop because that adds unnecessary calories and showed her how she should cook it, yet she continues to cook it the same way). when i refused once and for all and started to cook for myself, she said she didn’t even know who i was anymore. she continuously pokes fun at my thighs, knowing they're my biggest insecurity. she always asks what my weight is and despite me trying to help her lose weight in a healthy and sustainable way, she never listens or follows through.
• insults other people’s intelligence even though they’ve done nothing that proves her point (only when they disagree with her honestly)
• manipulates, lies, and gaslights everyday. pretends that she didn’t say something that she communicated to us a few hours prior and blames it on her memory
• splitting: sees people as either 100% good or bad, with her opinion changing within minutes
• exhibits anxious preoccupied protest behavior? i’ll say something she doesn’t like (ex: why did you this? that was out of line) and she’ll proceed to say she is not my mother anymore, never wants to see me again or have a relationship with me, and won’t eat food again (?), but then when i ignore her right back she comes back and continues conversation the next day like again, nothing ever happened. she has also said she is never coming back to the house, drives off for hours, and then returns without a word
• scolded me for crying when I was sad about something, stating that I can only cry when someone has passed
• guilts all of us for her pausing her career to raise us when we were younger, saying that by now she could have x amount of $ by now. but like, that was your choice... i didn't ask you to do that as an infant.
• proclaims to have little to no memory of anything described above, and gives a blanket statement that she has a lot of problems she doesn't know how to deal with
• threatens us that we can't put her in a nursing home when we're older (?) and says she will move wherever we move when we get our full-time jobs after college. i don't want that to happen, we both need a lot of space and time to heal

What do we do to help her while also distancing ourselves so she doesn't go ballistic?

Usually am not the kind of the person to air specific details of my family life, but I don’t really know who else to ask without doxing. We think she needs serious help.
Where to begin… essentially our mother reminds us of both a child and a Karen if that makes any sense? Here are some tidbits of the past 20 years.

• repeatedly makes threats of sui--- when something doesn’t go her way or angers her, starting when I was the age of 8
• one time I asked her a question on my science homework (she didn’t know the answer and also was annoyed at me asking), and she hit me on the head and I was so dizzy that I fell into the stove, which was on at the time. brought it up many years later and she laughed nervously asking if i was completely sure if that happened
• kicked my sister when she was 4, when she was asking her a quick way to distinguish left from right, because she was talking on the phone with her friend and didn’t want to be interrupted. also threw her stuffed animals across the room
• when something minor happened (we were about to be late for the bus and weren’t moving fast enough for her in elementary school), she pretended to have a mental breakdown/panic attack and faint on the floor. when I told her I was about to call 911 (I was scared out of my mind), she promptly got back up and acted like nothing ever happened
• when I told her I was severely depressed and had an ED, she complained that she didn’t know what other people in our community would think of her, and also pretended to stop breathing and fell on the floor AGAIN
• my sister had a knee injury from cross country, and when she asked our mom when the next appointment was, she blew up at her, started swerving the car purposely and driving recklessly, had a full on mental breakdown, honked the horn for long periods of time in the garage several times, pretended how to forget to open the garage door, and called her the spawn of Satan
• refused to talk to me ever again after I told her that I couldn’t do orchestra anymore because I was prioritizing adding more classes focused on my potential major, she proceeded to ignore me and deny my existence for almost a week. the only reason she started talking to me again was because there were two suicides at our school in one week. similar thing happened to my sister last year
• extremely clingy, needy, and possessive. i was instructed to send her good morning and good night texts everyday. i also had to always have my location on as an almost 21 year old. when i didn’t respond to good morning quickly enough once (was talking a shower after i slept in and didn’t see her text), i came back to dozens of calls and texts asking me what happened, and she was about to call the police to do a house check. extremely annoyed, i asked her to stop with the good mornings and good nights, and she reluctantly said ok and sent them anyway and called when i didn’t respond. also if i don’t send emojis in response to her when she does or mirror her exclamation points, she says that i’m mad at her
• when my sister cut her own bangs and it didn’t turn out the way she had hoped, my mom chased her with scissors and locked her in the garage until i had to beg her to get her out
• my mom is overweight, while my sister and i have always been slim/skinny, and it seems like this bothers her though she doesn’t explicitly say it. when i went on a recomp journey to gain more muscle and lose fat, she constantly criticized my mela because i refused to eat the food she cooked (she dumps oil on it and i have told her several times to stop because that adds unnecessary calories and showed her how she should cook it, yet she continues to cook it the same way). when i refused once and for all and started to cook for myself, she said she didn’t even know who i was anymore. she continuously pokes fun at my thighs, knowing they're my biggest insecurity. she always asks what my weight is and despite me trying to help her lose weight in a healthy and sustainable way, she never listens or follows through.
• insults other people’s intelligence even though they’ve done nothing that proves her point (only when they disagree with her honestly)
• manipulates, lies, and gaslights everyday. pretends that she didn’t say something that she communicated to us a few hours prior and blames it on her memory
• splitting: sees people as either 100% good or bad, with her opinion changing within minutes
• exhibits anxious preoccupied protest behavior? i’ll say something she doesn’t like (ex: why did you this? that was out of line) and she’ll proceed to say she is not my mother anymore, never wants to see me again or have a relationship with me, and won’t eat food again (?), but then when i ignore her right back she comes back and continues conversation the next day like again, nothing ever happened. she has also said she is never coming back to the house, drives off for hours, and then returns without a word
• scolded me for crying when I was sad about something, stating that I can only cry when someone has passed
• guilts all of us for her pausing her career to raise us when we were younger, saying that by now she could have x amount of $ by now. but like, that was your choice... i didn't ask you to do that as an infant.
• proclaims to have little to no memory of anything described above, and gives a blanket statement that she has a lot of problems she doesn't know how to deal with
• threatens us that we can't put her in a nursing home when we're older (?) and says she will move wherever we move when we get our full-time jobs after college. i don't want that to happen, we both need a lot of space and time to heal

What do we do to help her while also distancing ourselves so she doesn't go ballistic?

I had the most amazing experience in a medical setting, and I wanted to share it with a group that will be excited for me.
I went in yesterday around noon to check in. My boyfriend came with me, and they gave him a number to track where I was at on their giant tv in the waiting room. After an hour of waiting in the waiting room, the called me back to pre op. Got changed and climbed under some blankets that had warm air blowing under them. I answered some questions for the nurse, talked to the some other folks who were going to be assisting in my surgery.
I usually have terrible anxiety when it comes to needles. I mentioned to by surgeon that IVs are really scary for me and have had painful experiences both times I’ve had them. I was offered a shot to numb the back of my hand for the IV and it was so easy! The other nurse who I spoke with earlier popped her head in after and said “oh wow! That was quick!” And then looked at me “I’m so sorry. I should have been there to hold your hand!” Which I thought was super sweet. Then they grabbed my boyfriend from the waiting room while I signed all my forms, got my meds, went pee, and he got to meet my surgeon.
Finally, it was time for me to be wheeled back to surgery and him to go back to the waiting room. Once we started passing by other operating room, I started to feel the nerves. The operation room was huge with a big monitor with my all my relevant health info and bright lights. I scooted on to the table while they hooked up my arm and leg blood pressure cuffs, put a heart rate monitor on my earlobe, and gave me some oxygen before I got knocked out.
When I woke up in recovery, they gave me back my glasses and once I was more alert, the grabbed my partner. I was so happy to see him and cried a little bit. They gave me some oxy and gave me my meds to go home with and went over the discharge/home care info with my partner. They even sent me home with a couple of pictures! (My surgeon/OBGYN said it’s never too early to plan out the Christmas cards). The post op nurse had my boyfriend pull his car up while I got dressed and then I got wheeled out to his car. Of course the loading zone was packed so he had to park in the furthest end. Getting wheeled over there was the most painful part, going over those lines in the sidewalk felt like going over super tall speed bumps. But as we were driving home, the pain meds kicked in and I felt fine.
My boyfriend dropped me off and then got us some food and we relaxed on the couch. I could definitely feel my pain meds wear off, and kept timers to rotate and remember my rotation of meds. Other than that, my pain has been very well managed. Slept pretty well, even with the round the clock medication wake ups.
I definitely feel more tender today and have some good brushing around my incision below my bellybutton, but compared to my cramps I’m used to, this is a walk in the park! I notice that walking around and moving feels better on my incisions, and getting out of bed is probably the most “painful” part, but not too bad.
I am still in awe that I got this done finally! No more pregnancy tests or plan B if I forgot my birth control. I’ve opted to continue my birth control pills to manage my horrible never ending period, but now I don’t have to worry so much if I forget a pill. I truly thought this day would never come. I requested 3 weeks off dispute the recovery time typically being 2 since my job is so physical and mentally draining (ironically enough, I run a child are program) and was approved! I’m going to enjoy the next three weeks laying in bed with my dogs and not doing a whole lot else.
ETA: already reached out to the mods about adding my OBGYN who preformed my procedure. When we were going over the procedure, she asked me if I heard about this subreddit and the list of doctors (she had heard about it on TikTok) and I told her I actually tried to find a doctor on there that took kiaser but couldn’t find one that was taking patients and when I was trying to find an OBGYN off of the list. She mentioned that everyone in her practice would be more than willing to sign off on the procedure as long as they had thought it out, knew that it was permanent, and wanted it. She also joked about how she didn’t want to be on a list because she’s super busy, but whoops! She is truly the best doctor I’ve ever worked with, so I can’t not recommend her. Even my boyfriend thought she was amazing.

So this is a long post regarding SIL and going no contact
30th of November my 8 year old daughter was taken to hospital due to low oxygen due to a cold while in there she deteriorated quite extreme and ended up being transferred to a bigger hospital put on life support and unfortunately lost her life.
My daughter was three years old when I got with my partner and his parents have called themselves nanny and grandad since she was about 4 years old and treated her as a grandchild so regardless of DNA they are her grandparents however sister-in-law has always treated her like an outcast along with my older daughter that’s 13 and me and my partner have a three year old together but auntie is overbearing with him to the point my son cries every time she’s near him.
When my daughter was in hospital, my son was two,I’m still nursing to sleep so the hospital was happy to have him with me as he’s extremely clingy mummies boy. While my daughter was in hospital sister-in-law would message me asking how daughter was and offering to have my son that is extremely uncomfortable around her then when I politely declined her having my son but then would explain how my daughter was she would leave me on read because she didn’t get the answer she wanted rather than replying how my daughter was,then would message me the same thing practically the next day this went on for five days that we was in hospital where she offered to have my son then the message explaining how my daughter was doing which unfortunately was not doing well.
on the 5th of December, my daughter unfortunately passed away. I was with her and as you can imagine this destroyed me. Sister-in-law messaged me saying sorry for your loss blah blah blah nothing wrong with that part. Then it come to News getting around the town that my daughter had passed so I was receiving lots of messages on social media about my daughter so I just put a post up explaining what happened and then logged out of Facebook and stayed off social media for about a week. In that week SIL posted about how heartbroken she was that her niece had passed blah blah blah proper attention post considering she never once called my daughter niece in the whole time she was alive and was really milking social media.
When I did go back on I noticed she had done like five different posts about how heartbroken she was About my daughters passing bear in mind she never called her niece before in her whole life. For the sake of the family I didn’t bring it up plus I wasn’t sure if I’ve been extra sensitive due to grief
there was an autopsy performed because because they didn’t know exactly what happened since she had a common cold but unfortunately that virus attacked her heart so myocarditis was the reason, because everything had happened in December everything had been prolonged because the Christmas and New Year’s period.
my daughter didn’t get to the funeral directors until the 4th of January, I went to see my daughter on the 5th of January and asked my sister to watch my son for the first time ever my sister had watched my son and I’m not going to go into detail but my daughter had been passed for a month so as you can imagine seeing my daughter, she wasn’t in the best of ways, she didn’t look like herself and the best way to describe it is she was dead dead this really torn me up and I still have flashbacks to how she looked.
my partner receives a crappy message from his sister because it’s not fair that my sister got to watch Hunter and how this isn’t fair on her, she should’ve watched him which had actually shocked me that she would do that but it was the first ever time that my sister watched our son and given the situation that we had just gone to see my daughter‘s body who’s no longer with us I was extremely shocked that she could be that insensitive and entitled. I told partner I just couldn’t be around her for a little while. I won’t say anything to her. I’ll just avoid her to keep the peace then came January 15th that was my daughters funeral again obviously not an easy day. No parent should ever have to be planning a funeral for their child who was eight years old with her whole life ahead of her so not the best of days but his sister came she was nice on the day, no problems with her on that particular day the first thing she did when she got home was post pictures that she had taken and you know how hard it is blah blah blah on social media again for likes but I didn’t say anything. she asked if we could go round to her house, she still lives with her mum and dad and her partner and two children. she wanted us to go round there so me thinking maybe you know it’s it’s just checking in on us because of we’ve lost my a child but what it actually was was for her to give her personalised card and Teddy and a big amount of fuss to mine and my partners son asking him to be pageboy at her wedding , now this wedding is May 2026 so the fact that she needed to do it two days after my daughters funeral, didn’t sit right and that was when I actually finally had enough and I had to walk out because I could not sit through watching her try everything just to bring attention back on herself literally two days after we buried my daughter.
I didn’t hear from her at all and February comes my eldest daughter was 13 on the 22nd of February again no text nothing from sister-in-law then February 23 was my son’s third birthday my sister and my nieces and nephews came over. My partner Mum and Dad came over and they had brought my niece and nephew from that side of the family too so nobody mentioned anything about my sister-in-law so I assumed she wasn’t coming and was thankful for that then just as I’m about to do the cake I get told no wait for sister-in-law because she is coming. She didn’t even bother to let me know so then she gets there gives my son his presents and he’s got a lot more presents than usual and a voucher all fine. I do the cake and then they say it was lovely and leave then My daughter asked me if I could message my partners mum and dad to say thank you for her card and money as her birthday was the day before but being older she spent it with friends at the cinema so I stupidly said what did my partner sister get you assuming she would have got her a card at least even just a happy birthday but no she didn’t even say happy birthday to my daughter or hello so my daughter still getting the same treatment my other daughter got through life but then apparently was a niece once she died.
Then I noticed the post that sister-in-law had tagged me in about my son‘s birthday tag removed and the tag in my daughter’s funeral had also been removed and I was like okay then? But I’m not in the right mindset for drama so I just thought I’ll just remove as a friend on social media problems solved rather than this petty removing tag stuff,
within five minutes of me removing her straight away calling me a bitch and asking what my problem was with her so I explained from start to finish what my problem was with her and I explained that I don’t expect her to treat my oldest as her niece but I do expect her to at least say happy birthday to her and acknowledge that she is also human to which she replied that my daughter isn’t family so she will not be doing that and that she wasn’t using my other daughter for likes she would never do that even though she’s always been about attention and I snapped at that point and explained to her that if she can’t treat my children fairly on their birthdays then I don’t want her around on either of their birthdays to which my partner has hundred percent agreed with me, especially as I treat her two children exactly the same as my sister‘s children and class them as my nieces and nephews so that was how it was left
until she then messaged my partner explaining she is disgusted that I could say that she was using my daughter for likes when she would never do that and that she would never try and bring attention back to her the reason she picked two days after my daughters funeral for wedding stuff was because she was doing it for friends that lived far away too not that friends was there or anything so that was invalid. my partner then explained to her that there was no issue with her doing it for friends but it was not an acceptable time to do it when we have just lost a child.
I have decided to go no contact because I cannot bear to be anywhere near this woman and she has now messaged my partner moaning that she hasn’t seen my son for well since his birthday my partner has explained that I have gone no contact and that he agrees that if she can’t treat my children fairly, she doesn’t get to be around either of them so we have in fact taken the kids no contact too.
My partner has backed me. also, just as my daughter passed his sister went and like all of my Instagram posts with my daughter in from the last 5 years and commented on them about her beautiful niece even though she never liked her picture with my daughter and before this point. She also posted on New Year’s Eve about new chapter and how this was the best year of our life because she got engaged bare in mind that two weeks before that she was so heartbroken my daughter died but suddenly it was the best year ever. There’s a few more things she did but if I type them all I’ll be here all day.
Am I wrong for cutting contact because I’m in the middle grief? I have to second-guess everything in case it’s grief but I just feel the disrespect and entitlement that she has shown since the loss of my daughter is quite frankly something that I never want to be around because I could not imagine being that way to anyone that has just lost a child. But am I right for these feelings and cutting her from my son’s life? Can I have honest opinions please

how do i know if its side effects from my meds or me creating the feeling?
I need help. I started taking concerta in february, during the titration it went fine until i got to 36mg. I started feeling cold in my hands and feet, get a higher heart rate, feel nauseous etc. After around 1 week it felt better and i started to take 52mg. The side effects got a lot worse and i had a heart rate around 110-130 all day until the medicine wore off. This lasted for about 3 weeks. I tried to go back to 36 mg which didn’t help.
My nurse decided that I should try elvanse (vyvanse) instead. Started with 30 mg which went so well. I felt calmer and less side effects. Went up to 50mg and the first 2-4 days i had a higher heart rate which became more stable after 1 week. Higher heart rate in this case was around 90-100 while working by my computer. Then i went up to 70mg, the final dose. The side effects were there the first week. I had drier mouth, shaky hands, higher heart rate (100-110) but it still was better than with concerta. After 2,5 weeks with 70mg the side effects started to wear off and some days I was even wondering if I even took the meds because I couldn’t feel anything special. My heart rate was more stable around 90-95 while working. Since my blood pressure and heart rate also looked good every time I visited my nurse we decided that I didn’t need to go to her every week anymore.
This was a week ago. The last week I’ve been feeling stressed. I feel my heart rate more often and it sometimes peaks to 110-120 for maybe 1-2 hours when the medication kicks in. I also have a peak directly after lunch. My hands are also a bit more shakier. The thing is that this makes me worry about my heart health. What if my heart rate is dangerous for me? How do I know if this is side effects from my medication or if me worrying is the reason for my heart rate to be high? How do I know? I’ve also read that the effectiveness of the medication can vary depending on where u are at the menstrual cycle. When my heart rate was stable around 90 and I barely felt any side effects I was on my period. What if that was the reason why it felt different that week?
All these thoughts are driving me nuts and I get stuck googling what heart rate a person on stimulants should have. This makes me even more stressed.
I really don’t wanna switch medications again since the titration is so stressful for me. It gives me so many reasons to overthink. I overthink so much about the side effects and the wanted effect. I panic about the fact that I’m the one who has to know if it works, how I feel etc. It’s like i start to question my self and my ability to describe what i feel correctly and also to remember how i feel compared to the time before medication.
Please help. Have any of you had the same issue and thoughts?

how do i know if its side effects from my meds or me creating the feeling?
I need help. I started taking concerta in february, during the titration it went fine until i got to 36mg. I started feeling cold in my hands and feet, get a higher heart rate, feel nauseous etc. After around 1 week it felt better and i started to take 52mg. The side effects got a lot worse and i had a heart rate around 110-130 all day until the medicine wore off. This lasted for about 3 weeks. I tried to go back to 36 mg which didn’t help.
My nurse decided that I should try elvanse (vyvanse) instead. Started with 30 mg which went so well. I felt calmer and less side effects. Went up to 50mg and the first 2-4 days i had a higher heart rate which became more stable after 1 week. Higher heart rate in this case was around 90-100 while working by my computer. Then i went up to 70mg, the final dose. The side effects were there the first week. I had drier mouth, shaky hands, higher heart rate (100-110) but it still was better than with concerta. After 2,5 weeks with 70mg the side effects started to wear off and some days I was even wondering if I even took the meds because I couldn’t feel anything special. My heart rate was more stable around 90-95 while working. Since my blood pressure and heart rate also looked good every time I visited my nurse we decided that I didn’t need to go to her every week anymore.
This was a week ago. The last week I’ve been feeling stressed. I feel my heart rate more often and it sometimes peaks to 110-120 for maybe 1-2 hours when the medication kicks in. I also have a peak directly after lunch. My hands are also a bit more shakier. The thing is that this makes me worry about my heart health. What if my heart rate is dangerous for me? How do I know if this is side effects from my medication or if me worrying is the reason for my heart rate to be high? How do I know? I’ve also read that the effectiveness of the medication can vary depending on where u are at the menstrual cycle. When my heart rate was stable around 90 and I barely felt any side effects I was on my period. What if that was the reason why it felt different that week?
All these thoughts are driving me nuts and I get stuck googling what heart rate a person on stimulants should have. This makes me even more stressed.
I really don’t wanna switch medications again since the titration is so stressful for me. It gives me so many reasons to overthink. I overthink so much about the side effects and the wanted effect. I panic about the fact that I’m the one who has to know if it works, how I feel etc. It’s like i start to question my self and my ability to describe what i feel correctly and also to remember how i feel compared to the time before medication.
Please help. Have any of you had the same issue and thoughts?

how do i know if its side effects from my meds or me creating the feeling?
I need help. I started taking concerta in february, during the titration it went fine until i got to 36mg. I started feeling cold in my hands and feet, get a higher heart rate, feel nauseous etc. After around 1 week it felt better and i started to take 52mg. The side effects got a lot worse and i had a heart rate around 110-130 all day until the medicine wore off. This lasted for about 3 weeks. I tried to go back to 36 mg which didn’t help.
My nurse decided that I should try elvanse (vyvanse) instead. Started with 30 mg which went so well. I felt calmer and less side effects. Went up to 50mg and the first 2-4 days i had a higher heart rate which became more stable after 1 week. Higher heart rate in this case was around 90-100 while working by my computer. Then i went up to 70mg, the final dose. The side effects were there the first week. I had drier mouth, shaky hands, higher heart rate (100-110) but it still was better than with concerta. After 2,5 weeks with 70mg the side effects started to wear off and some days I was even wondering if I even took the meds because I couldn’t feel anything special. My heart rate was more stable around 90-95 while working. Since my blood pressure and heart rate also looked good every time I visited my nurse we decided that I didn’t need to go to her every week anymore.
This was a week ago. The last week I’ve been feeling stressed. I feel my heart rate more often and it sometimes peaks to 110-120 for maybe 1-2 hours when the medication kicks in. I also have a peak directly after lunch. My hands are also a bit more shakier. The thing is that this makes me worry about my heart health. What if my heart rate is dangerous for me? How do I know if this is side effects from my medication or if me worrying is the reason for my heart rate to be high? How do I know? I’ve also read that the effectiveness of the medication can vary depending on where u are at the menstrual cycle. When my heart rate was stable around 90 and I barely felt any side effects I was on my period. What if that was the reason why it felt different that week?
All these thoughts are driving me nuts and I get stuck googling what heart rate a person on stimulants should have. This makes me even more stressed.
I really don’t wanna switch medications again since the titration is so stressful for me. It gives me so many reasons to overthink. I overthink so much about the side effects and the wanted effect. I panic about the fact that I’m the one who has to know if it works, how I feel etc. It’s like i start to question my self and my ability to describe what i feel correctly and also to remember how i feel compared to the time before medication.
Please help. Have any of you had the same issue and thoughts?

Are you a life sciences graduate who is currently in the BPO industry with a toxic work environment?
If not, are you a fresh graduate with a degree in life science who is looking for your first job opportunity?
Or you could be a life science graduate (or even a license holder) who is looking into changing career paths.
This opportunity may be for you.
Thermo Fisher Scientific is currently hiring Medical Information Specialists to start on JULY!
Job Description Overview:

• Provides technical and medical information, and/or performs intake of adverse events/ product complaints with quality customer service.
• Analyzes and researches inquiries and documents interactions according to organizational, client and regulatory guidelines.
• The information provided will be given to a level in parallel with the individual’s expertise, experience, and training.

Minimum Qualifications:

• MUST be a graduate of Bachelor of Science in Life Science courses (Pharmacy, Nursing, Biology, Medical Technology, Psychology, and etc. – Chemistry is not considered)
  • Fresh Graduates are welcome to apply! (Trust me, we hire a lot of eligible and skillful fresh graduates.)
  • Applicants without BPO or Contact Center experience are welcome to apply! (We can train you! This is not a hard-core call center.)
• Excellent English Communications Skills – both speaking and writing.
  • Must be willing to undergo English Language Assessment (if required)
• Must be amenable to work on Night Shift (US Office hours).
• Must be amenable to work in BGC, Taguig (Main Office) 5x a week during training.
• Must be amenable to work in a Hybrid work setup (1 to 3x a week onsite after training period)
• Must be amendable to do 10 - 11 calls per shift. (I repeat, this is not a hard-core contact center!)

*Salary Package: 32k to 38k
Benefits:

• Hybrid work set-up after training! (1 to 3x a week onsite)
• HMO (Medical, Dental, Mental Health) upto 2 dependents
• Vacation Leaves
• Sick Leaves
• Insurances
• Hardware and other peripherals provided by us!
• Guaranteed 2 days off weekly!

\Salary Package - Offer MAY vary per applicant.*
PLEASE NOTE! Hiring process is tedious and may take time. Be patient and wait for the communication from our Talent Acquisition Team and Hiring Managers.

To apply, send me a DM!

Are you a life sciences graduate who is currently in the BPO industry with a toxic work environment?
If not, are you a fresh graduate with a degree in life science who is looking for your first job opportunity?
Or you could be a life science graduate (or even a license holder) who is looking into changing career paths.
This opportunity may be for you.
Thermo Fisher Scientific is currently hiring Medical Information Specialists to start on JULY!
Job Description Overview:

• Provides technical and medical information, and/or performs intake of adverse events/ product complaints with quality customer service.
• Analyzes and researches inquiries and documents interactions according to organizational, client and regulatory guidelines.
• The information provided will be given to a level in parallel with the individual’s expertise, experience, and training.

Minimum Qualifications:

• MUST be a graduate of Bachelor of Science in Life Science courses (Pharmacy, Nursing, Biology, Medical Technology, Psychology, and etc. – Chemistry is not considered)
  • Fresh Graduates are welcome to apply! (Trust me, we hire a lot of eligible and skillful fresh graduates.)
  • Applicants without BPO or Contact Center experience are welcome to apply! (We can train you! This is not a hard-core call center.)
• Excellent English Communications Skills – both speaking and writing.
  • Must be willing to undergo English Language Assessment (if required)
• Must be amenable to work on Night Shift (US Office hours).
• Must be amenable to work in BGC, Taguig (Main Office) 5x a week during training.
• Must be amenable to work in a Hybrid work setup (1 to 3x a week onsite after training period)
• Must be amendable to do 10 - 11 calls per shift. (I repeat, this is not a hard-core contact center!)

*Salary Package: 32k to 38k
Benefits:

• Hybrid work set-up after training! (1 to 3x a week onsite)
• HMO (Medical, Dental, Mental Health) upto 2 dependents
• Vacation Leaves
• Sick Leaves
• Insurances
• Hardware and other peripherals provided by us!
• Guaranteed 2 days off weekly!

\Salary Package - Offer MAY vary per applicant.*
PLEASE NOTE! Hiring process is tedious and may take time. Be patient and wait for the communication from our Talent Acquisition Team and Hiring Managers.

To apply, send me a DM!

Are you a life sciences graduate who is currently in the BPO industry with a toxic work environment?
If not, are you a fresh graduate with a degree in life science who is looking for your first job opportunity?
Or you could be a life science graduate (or even a license holder) who is looking into changing career paths.
This opportunity may be for you.
Thermo Fisher Scientific is currently hiring Medical Information Specialists to start on JULY!
Job Description Overview:

• Provides technical and medical information, and/or performs intake of adverse events/ product complaints with quality customer service.
• Analyzes and researches inquiries and documents interactions according to organizational, client and regulatory guidelines.
• The information provided will be given to a level in parallel with the individual’s expertise, experience, and training.

Minimum Qualifications:

• MUST be a graduate of Bachelor of Science in Life Science courses (Pharmacy, Nursing, Biology, Medical Technology, Psychology, and etc. – Chemistry is not considered)
  • Fresh Graduates are welcome to apply! (Trust me, we hire a lot of eligible and skillful fresh graduates.)
  • Applicants without BPO or Contact Center experience are welcome to apply! (We can train you! This is not a hard-core call center.)
• Excellent English Communications Skills – both speaking and writing.
  • Must be willing to undergo English Language Assessment (if required)
• Must be amenable to work on Night Shift (US Office hours).
• Must be amenable to work in BGC, Taguig (Main Office) 5x a week during training.
• Must be amenable to work in a Hybrid work setup (1 to 3x a week onsite after training period)
• Must be amendable to do 10 - 11 calls per shift. (I repeat, this is not a hard-core contact center!)

*Salary Package: 32k to 38k
Benefits:

• Hybrid work set-up after training! (1 to 3x a week onsite)
• HMO (Medical, Dental, Mental Health) upto 2 dependents
• Vacation Leaves
• Sick Leaves
• Insurances
• Hardware and other peripherals provided by us!
• Guaranteed 2 days off weekly!

\Salary Package - Offer MAY vary per applicant.*
PLEASE NOTE! Hiring process is tedious and may take time. Be patient and wait for the communication from our Talent Acquisition Team and Hiring Managers.

To apply, send me a DM!

Are you a life sciences graduate who is currently in the BPO industry with a toxic work environment?
If not, are you a fresh graduate with a degree in life science who is looking for your first job opportunity?
Or you could be a life science graduate (or even a license holder) who is looking into changing career paths.
This opportunity may be for you.
Thermo Fisher Scientific is currently hiring Medical Information Specialists to start on JULY!
Job Description Overview:

• Provides technical and medical information, and/or performs intake of adverse events/ product complaints with quality customer service.
• Analyzes and researches inquiries and documents interactions according to organizational, client and regulatory guidelines.
• The information provided will be given to a level in parallel with the individual’s expertise, experience, and training.

Minimum Qualifications:

• MUST be a graduate of Bachelor of Science in Life Science courses (Pharmacy, Nursing, Biology, Medical Technology, Psychology, and etc. – Chemistry is not considered)
  • Fresh Graduates are welcome to apply! (Trust me, we hire a lot of eligible and skillful fresh graduates.)
  • Applicants without BPO or Contact Center experience are welcome to apply! (We can train you! This is not a hard-core call center.)
• Excellent English Communications Skills – both speaking and writing.
  • Must be willing to undergo English Language Assessment (if required)
• Must be amenable to work on Night Shift (US Office hours).
• Must be amenable to work in BGC, Taguig (Main Office) 5x a week during training.
• Must be amenable to work in a Hybrid work setup (1 to 3x a week onsite after training period)
• Must be amendable to do 10 - 11 calls per shift. (I repeat, this is not a hard-core contact center!)

*Salary Package: 32k to 38k
Benefits:

• Hybrid work set-up after training! (1 to 3x a week onsite)
• HMO (Medical, Dental, Mental Health) upto 2 dependents
• Vacation Leaves
• Sick Leaves
• Insurances
• Hardware and other peripherals provided by us!
• Guaranteed 2 days off weekly!

\Salary Package - Offer MAY vary per applicant.*
PLEASE NOTE! Hiring process is tedious and may take time. Be patient and wait for the communication from our Talent Acquisition Team and Hiring Managers.

To apply, send me a DM!