After months of my practitioners barely giving me enough medicine to keep the yeast at bay following multiple rounds of powerful antibiotics. They said I qualified for the appointment based on the duration of my symptoms and the yeast not responding to traditional care. I have tested negative for STIs, autoimmune disorders, and multiple scans of my body have revealed absolutely nothing. Most of my tests have returned negative for yeast despite obvious yeast as witnessed by myself and several doctors.
My symptoms
Oral thrush mostly on tongue Burning tongue Sore throat Sore glands
Anal itching and discomfort Red yeast rashes Pain
Vaginal thrush Constant tingling and itching sensation across entire vaginal area
Severe low back and pelvic pain Occurs randomly Shoots down legs Hard to tell if nerve or muscular Started at same time as yeast
Symptoms flare with alcohol and sugar and with sweating
Has anyone gone to ID and had a successful encounter? I feel like this yeast is slowly killing me.

0600 - The Vengeful Spirit

It was supposed to be normal, standard even. A Druhkari attack on the world they were in current diplomatic actions with for their compliance and joining the fold of the Imperium. Surprising, but not shocking, the planetary leaders had mentioned that they had to deal with Druhkari slavers from time to time. This was expected to be rather quick, as this world wanted to join the Imperium, for both protection and resources, so I did not join Hathor planet side.
It was a small detachment of Druhkari slavers, not expecting the Emperors finest. They would push back and eliminate the Druhkari, or as worst set a defensive line and flank. They had everything in advantage, and was mostly expected the Druhkari would retreat when witnessing their disadvantage. So I remained aboard the flagship, sitting near low orbit, passing the time with training.
I felt a sharp pain as the wooden sparring sword dug between his ribs, pulling him from his thoughts, and shoving him to the ground. He laid there wheezing for a moment, trying to catch his breath when the imposing figure of Sargent Decurius loomed into view. Even silhouetted by the light behind the Sargent as he leaned over him, he cloud still see the slow smile draw itself across his face.
"You're distracted sir." He reached out a hand to help me up, the size dwarfing my own as I reached upwards to grab it. He fully clasped his hand around mine, like an adult would a toddler, and gently helped pull me to my feet.
"It's hard not to be." I responded, slowly catching my breath as I leaned on my wooden sword. Though I was drenched in sweat and marred by bruises, the Sargent was untouched by both my sword and fatigue. "Druhkari are viscous things, and not to be underestimated, and we haven't heard from them since the attack begun an hour ago."
"She's fought them before sir, and plenty more things. It's common for the start of the battle to have little communication with the flagship. When they get into a stable position and establish a front line they will disseminate information and dictate further orders for the troops waiting in orbit...just like always sir."
His tone was even, almost logical in nature, yet I understood why. I was letting my emotions get the best of me, he was attempting to ground me by countering my fears with facts. I smiled at the honest attempt walking over to the pitcher of water that awaited the both of us.
"Thank you Sargent. Not too long ago you would have told be to silence my babbling or go find a nursemaid to cry to."
I poured us both a glass as he cringed slightly at the comment. "It's thanks to you sir. My time with Brother Sresh of the Salamanders was most insightful. Without it, I would not have been able to enjoy the time I have shared with you as I do now."
"Don't thank me Sargent. I simply recognized where you could grow, and an environment where you could do it. It is the duty of all of us to learn and improve. Just as I learn the sword, you learn the soul. The difference is that you are a teacher and pupil, where I am just a pupil. Who you should send your thanks to is who taught you." He gave me a strange look as I handed him his glass, though as soon as I noticed it, it vanished.
I had seen a few marines wear a similar look, but it was a flicker of emotion. One that could not be studied or understood without delving into their very mind or questioning them. If a marine purposefully hid an emotion or thought, no question he could ask would drive it out. Still the Sargent held out his glass of water, offering a simple toast. For a second I thought he was holding the pause just before he spoke for a few moments longer than needed as he knew my thirst, but he finally relented.
"To growth." He said holding his glass out. "To growth." I responded, my glass meeting his before it begun the eager journey to quench my thirst. Just as the water was about to touch my lips the doors burst open. Red faced and breathing heavy was a servant, eyes feverishly searching the room until they landed on me.
"SIR REKEM!" He shouted, barely able to force the words out between labored breaths. I withheld me sigh as my glass was pulled from my lips. "Alright calm down now, I can't have you dropping dead from exhaustion. I'm finishing up my sparring so give me some ti-"
"THE COMMANDER IS INJURED." He chocked out once more, a fit of coughing brought on right after. The silence in the room was physical, like a spell everyone and everything seemed to freeze in time as if that statement was a mystical chant to hold the world still.
Time resumed when the glass from my hand shattered on the floor. The Sargent pulled from his daze rushed over to the pitcher and handed it to the exhausted servant. He turned his head to me to seem my robe flutter out the door and down the hallway. Apparently he was calling my name, I wouldn't know. I couldn't hear anything but the blood in my ears.

0610 - The Helm of the Vengeful Spirit

I rushed to the helm as fast as my legs could carry me though the winding hallways of the void ship. As the doors to the helm came into view the two marines standing guard almost made a half step to stop me until they recognized who I was. For their sake I slowed my run to a stalking march as they opened the doors for me. I skipped the usual thanks and conversation I would start with them, hopping they would understand.
The Sargent for his merit was not far behind me, having become my unofficial bodyguard in the times that Hathor was not onboard the ship. The entire helm seemed to hold it's breath as I stormed in, a crowd of marines standing around a holographic map of the supposed battlefield. Among them Loken stepped forward, hands raised with a prepared speech on his lips.
"Loken the only thing that better leave your mouth is what I want to know or it will be sewn shut."
His mouth snapped shut, turmoil crossing his face as he weighed his options before he finally let out a sigh. "We don't know much. Most communications are being blocked across a large sector, our vox operators assume it to be Xeno tech. Certain transmissions seem to be allowed to get through, but from what we can see this leads to confusion and ambushes." He directed me to the map of the battle field, showing the last known positions of various troops.
"Our forces were pulled into the desert just outside the capital to engage the Xeno's. A vox transmission sent from Captian Kibre managed to breech through the static to tell us that the commander was wounded. Before any further information could be relayed the transmission was shut off."
I nodded and scanned the map as he spoke, recalling my sessions with Minerva as I did so. I wish she was here at this moment, her and Juno would be a godsend against the Druhkari. The creeping weight of the severity of the situation was also something I did not know if I could carry alone. I took a deep breath, turning to Loken. "That is what we know, now what do we think."
Loken was a genius, and Captian of the 10th for a reason. As I asked his eyes returned to the map, his focus drew inward as no doubt hundred of possibilities and plans where conjured, analyzed, and discarded in seconds until only a few remained. Finally he spoke, the lighter tone he used when relaying information was gone. No doubt he as well was doing his best to soften the blow of the news, but now that he was asked for answers he would deliver them.
"The primary information given was the fact the Commander was injured. This means that information was the highest priority, given that such a transmission has never happened before, we can assume that the commander is gravely injured." The phrase alone seemed to suck the air out of the room. If anyone else in any other situation had uttered such a thing they would be seen as mad or as disgracing the capabilities of the commander. I gave a single nod to Loken. "Continue."
"We do know that this is a detachment of Druhkari slavers, but we are taking no precautions to hide our forces. Meaning they either attacked knowing they could fight against us, or attacked knowing we where here. The Druhkari could have attacked any other part of the planet and we would have had a delayed response, but they attacked the only part in which there were members of the Imperium."
The weight of the situation seemed to fall past my shoulders and rest somewhere in my stomach, drawing down a deep pit which only seemed to grow as I slowly reached the conclusion that Loken was describing. Still he continued on, and I hoped that he wouldn't say what I was fearing.
"The fact that the commander was both attacked and injured to an extent to relay it to the flagship, makes me think that either her or someone on the flagship is the target of the slavers." On saying someone he turned to me, as seemingly everyone else on the bridge did. My hands tightened on the metal rim of the holographic map, knuckles turning white. Silence once again gripped the room, settling in my throat like a lump that threatened to choke me. I took another deep breath, loosing myself to my emotions wouldn't help the commander, but I also wouldn't forget them.
"Sargant." I barked out, startling some of the helmsmen as i stood ram rod straight. "Prepare a dropship and yourself immediately. Bring five others of your choice, I trust in your judgement. Call for Apothecary Hannibus, he will be joining us as well. I ne-" Loken cut in, stepping forward.
"Sir this could very well be a trap, for you or anyone else that would go. The commander also stated that you were to st-"
I rounded on him, fire in my eyes as rage seemed to burn my skin. "Captain. With the Commander injured and missing, I am taking command of the Vengeful Spirit and the Luna Wolves. As her consort am I not her second in command of all things?"
I could see the conflict in his mind as it crossed his face briefly. My claims stood on little more than ceremony rather than practiced tradition. Any other officer had a stronger claim to take control of the army than I did right now, but although it was a technicality, it still existed in Imperium law. His voice one against dropped into a lighter tone, an attempt at soothing rather than relaying of analytical information.
"Sir I understand how you feel but now is not the time to be rash. The commander has been thr-" I cut him off once more, my voice raising above his gentle tone.
"I am going to save my wife, Captain. Now you can either kill me or join me becuase anything else won't work and is a waste of my time." Shock wove it's way through the room in a wave. I had always been formal with the Commander, and her with me. Outside of those I regularly spoke with, this statement would certainly come as a surprise. Loken gained control of himself quickly, nodding in response. "I am with you sir."
"Good, stay here and take control of the helm." I turned to leave when he raised his voice in confusion.
"But sir you sai-"
"I know what I said Captain, but your place beside me right now is here. There is a reason the Commander left you here and there is a reason I am. I can not control this fleet, nor can I place reinforcements or respond to flanks. I need someone who can, someone with experience, and who has the trust of many to follow these strategies. Can I trust you to do this Captain?" Loken stalled for a moment, no doubt looking at the possibilities of this action, seeking the best choice he could. Finally after a few seconds he smiled and gave a nod. "Yes sir, you can."
"Good, you have the helm. Sargent with me." I turned on my heel, marching out of the helm to gather what I needed and prepare myself. As the doors closed behind us and we distanced ourselves from the guards I heard the Sargant's voice break the rhythmic beat of our footsteps. "That's the first time you addressed the Commander as your wife Sir."
"Is that going to be a problem Sargant?" Even though I did not turn my head I could feel his smile form on his face as he responded. "No Sir."
I nodded at his answer. "Good, becuase your going to be hearing it a lot more. Now, gather your men and the apothecary, we meet at the drop pods in a half hour." The Sargent turned at an intersection, now sprinting down the halls at a speed I could not hope to match as I made my way to my quarters. I could not tell which emotion was greater in me at the moment. The rage that made my blood feel like fire, or the worry that sunk into my stomach like a bottomless pit. Both spurred me to match the Sargant's idea, and broke into a run to my quarters.

It has to be me, right? I've tried foam, I've tried thick creams, and my current favourite is a thin moisturizing one. I've used electric razors (flat and round heads, I couldn't believe how little they did, quite literally no hair removed at all in places), disposables, cartridge.
I have a Henson now, and it's... Better? It's the default blades that come with the thing. I do it with the grain, sideways, and only against after that. I pull my skin tight. I let the razor be the weight, and don't push much. Though, obviously, I've tried every variation I could.
It takes about 15 strokes per spot to shave it. I'm not picky, I'm not looking for a close shave, just not... Completely visible. It takes so goddamn long to shave, I'm just lucky I only need to every 2-3 days. I'll admit I have cystic acne, so I'd expect it to be rougher around the cysts, but even in the clear places, it's not much better. I also get a lot of razor burn no matter what I do, lots of red dots and rashes, but I'm chalking that up to how many strokes I need.
What on earth is there left to do?

It has to be me, right? I've tried foam, I've tried thick creams, and my current favourite is a thin moisturizing one. I've used electric razors (flat and round heads, I couldn't believe how little they did, quite literally no hair removed at all in places), disposables, cartridge.
I have a Henson now, and it's... Better? It's the default blades that come with the thing. I do it as y'all suggest, with the grain, sideways, and only against after that. I pull my skin tight. I let the razor be the weight, and don't push much.
It takes about 15 strokes per spot to shave it. I'm not picky, I'm not looking for a close shave, just not... Completely visible. It takes so goddamn long to shave, I'm just lucky I only need to every 2-3 days. I'll admit I have cystic acne, so I'd expect it to be rougher around the cysts, but even in the clear places, it's not much better. I also get a lot of razor burn no matter what I do, lots of red dots and rashes, but I'm chalking that up to how many strokes I need.
What on earth is there left to do? How can I make wet shaving actually work, and like, shaving at all?

The dull thrum of voices, echoing throughout the grand senate hall, slowly died down, as the Emperor rose to speak. All eyes turned to face the figure, at the head of the chamber. Though his expression remained stern and composed, an air of unease flickered behind his large compound eyes.
The Emperor began,
"My fellow senators, yesterday we received grave news from the frontier. Ambassador Grax's statement confirmed, that humans did not wish to cooperate with the empire.
Grax attempted to demand for a tribute to the empire, but humans refused.
He attempted to teach humans a lesson and demonstrate our military power, but in a single combat, nearly three hundred of our finest warships were destroyed."
A collective murmur swept through the assembled Vraxians, at this somber revelation. So many lost in the blink of an eye, at the hands of an outsider species, that has only recently been discovered, and planned by Vrax empire, to be in cooperated, as a new vassals of the emperor.
The Emperor continued, "While the details are still emerging, one fact is clear. We are facing an enemy with capabilities far beyond anything we have previously encountered. One of their war machines alone, decimated over half of Grax's armada before he was forced to surrender."
At this, angry shouts erupted from the hardliner factions. Senator Vortok, a prominent military advocate, slammed his fists on the armrest. "This outrage cannot be tolerated! We must retaliate with our full might, and crush these humans under our heel."
A chorus of approval rose in response. However, others called for restraint. Councilor Trexel of the Diplomatic Legion, projected his voice to be heard over the din.
"While vengeance may assuage our wounded pride, it will not ensure our continued survival. Rushing headlong into battle, could spell the end of our species."
As tensions threatened to boil over, the Emperor raised his hands, and the chamber slowly fell back into an uncomfortable silence. "My friends, in these dark times, we must come together with clear heads, not tear each other apart. Councilor Trexel speaks wisdom, we know little of our new enemies, and acted rashly before. Another hasty demand on humans, could seal our doom."
Senator Vortok spat in disgust. "For generations, we have expanded the borders of our glorious empire, through strength of arms! Now you preach cowardice, and appeasement?"
The Emperor turned to face him directly, his eyes narrowing. "I preach nothing but caution, which has always guided our people through countless wars, and plagues. Would you risk intergalactic war, to soothe your damaged pride? There is too much at stake."
The Emperor's sober words hung heavy in the air, as discussion stirred once more, among the assembled senators. Councilor Trexel spoke up, to address Senator Vortok's outburst.
"Strength alone will not assure victory in this new conflict. These humans overwhelmed Ambassador Grax's fleet, with technology far beyond our own. We know little of their world, their numbers, or their true capabilities. Charging in blind would be the height of foolishness. I say we devote our shipyards to rebuilding our fleet, while spies learn what they can of this race."
"Reconnoiter and rebuild?" scoffed Vortok. "You coddle our warriors with hesitation and fear. Our fleet was taken unawares, next time it will be different. Double our forces and sweep across the frontier. Teach these upstarts the price of defiance."
Trexel shook his head solemnly. "Even doubled, our forces mean nothing, if we do not counter whatever advantage felled Grax. We must understand our enemy, before engaging them at full scale,, or risk obliteration."
Admiral Korfax, commander of the Vraxian fleets, spoke up in support of Trexel. "As the one, tasked with leading our warriors into battle, I say caution is warranted. Superior numbers alone, will not undo an enemy, capable of such devastation. Give me time to analyze the battle and reports, to glean some insight into their tactics and technologies. Only then, can we craft a prudent strategy."
Senator Zornak of the imperial ministry interjected, "And what of our citizens, while we cower in hiding? Word of this disaster will spread; morale and faith in our rule will falter. Inaction, will bleed us dry, as effectively as any foe. We must act, to restore confidence and control!"
Trexel turned to the Emperor. "Noble Zornak raises a fair point. While military strength is crucial, we cannot neglect the spirits of our people, and other species under our protection. I propose a show of resolution, bolster border defenses, reinforce outlying colonies, commission more warships. Let our subjects see we mean to secure our domain, while avoiding reckless attacks that risk further losses."
Vortok snarled in contempt. "Defensive posturing, and reactionary policies? You would have our empire a quivering coward, before these humans. We should meet them head-on, and break their will to fight, as our forebears did to all who opposed us!"
"Or drive them to desperation, where they unleash terror, we cannot imagine," countered Trexel. "The wars of old forged our domain, but brought untold suffering too. Must we court annihilation, to satisfy your thirst for blood?"
The debate raged on, with tensions rising between the militant and cautious factions. No consensus seemed within reach, as positions polarized. Then Admiral Korfax spoke again, his words cutting through the verbal melee.
"My lieutenants have analyzed the parts of the battle, and transmissions from Grax's final battle. The enemy utilized advanced plasma weapons, and shielding far more potent, than any technology we have, according to analyses. Furthermore..." He paused gravely. "Sensors detected over 200 warships orbiting their world, not big as one, that destroyed Grax's fleet. My analytics doesn't think, that those humans have more of the so called Dreadnought ships in orbit.
Murmurs erupted at this revelation. Even Zornak seemed taken aback, at the scale of the human numbers and strength. But they still have only one Dreadnought class ship; if they could disable it in any way, he wondered.
Korfax pressed on.
"I once advocated meeting force with force, but no amount of reinforcements, or bravado can overturn such a gulf. Councilor Trexel is right, we must pull back inside our borders, consolidate our forces, and learn all we can, how to counter, these humans on equal footing. Only then can we ensure victory, instead of futile sacrifice. Anything less could will see our domain, fall to this new power."
A hush fell over the chamber, as the full magnitude of the crisis, took hold. The Emperor rose, and regarded his divided court, with a grim expression.
"Admiral Korfax speaks the bitter truth we must accept, no matter the hurt to our pride. From this day, reconstruction and Intelligence become our highest priorities. All fleets are hereby recalled, to the border systems, for refit and rearmament. Councilor Trexel, the Diplomatic Corps is charged with gathering what information your spies, and envoys can obtain of our new enemy. Only with time, study, and a new approach, will we emerge from this darkness, with our empire intact."
A somber acceptance met his declaration. The Vraxian Empire faced its greatest test, and survival would demand, abandoning old assumptions. War remained an option, but prudence said victory lay down, a different path for now. The humans had thrown down a gauntlet, and the Vraxians' response, would shape their realm's destiny.
As the debate raged on, two young Vraxian warriors watched from the upper viewing balconies, reserved for guests and citizens. Sergeant Maknor gripped the railing tightly, his aged exoskeleton creaking under the pressure. "This Senate squabble will come to nothing. The humans have shamed us, and must answer for it in blood."
His companion, Lieutenant Fylox, was less certain. "And if more of their mighty war machines, stand between us? You saw the footage of the engagement, same as I. One destroyed hundreds, of our finest cruisers, in the span of hours."
Maknor rounded on him fiercely. "So we should cower, like trembling hatchlings, instead of restoring our honor? There are trillions of us, and we command the greatest fleets, the galaxy has ever seen. Numbers and courage will carry the day, as they always have!"
Fylox started to reply, but was cut off, by an eruption of cheers from below. It seemed the hardliners had gained ascendency once more. The Emperor's words of reason, were being drowned out, by collective grievance, and longing for vengeance. As the debate threatened, to boil over into open violence, it seemed war with the aliens from system of Sol, was becoming inevitable.

The dull thrum of voices, echoing throughout the grand senate hall, slowly died down, as the Emperor rose to speak. All eyes turned to face the figure, at the head of the chamber. Though his expression remained stern and composed, an air of unease flickered behind his large compound eyes.
The Emperor began,
"My fellow senators, yesterday we received grave news from the frontier. Ambassador Grax's statement confirmed, that humans did not wish to cooperate with the empire.
Grax attempted to demand for a tribute to the empire, but humans refused.
He attempted to teach humans a lesson and demonstrate our military power, but in a single combat, nearly three hundred of our finest warships were destroyed."
A collective murmur swept through the assembled Vraxians, at this somber revelation. So many lost in the blink of an eye, at the hands of an outsider species, that has only recently been discovered, and planned by Vrax empire, to be in cooperated, as a new vassals of the emperor.
The Emperor continued, "While the details are still emerging, one fact is clear. We are facing an enemy with capabilities far beyond anything we have previously encountered. One of their war machines alone, decimated over half of Grax's armada before he was forced to surrender."
At this, angry shouts erupted from the hardliner factions. Senator Vortok, a prominent military advocate, slammed his fists on the armrest. "This outrage cannot be tolerated! We must retaliate with our full might, and crush these humans under our heel."
A chorus of approval rose in response. However, others called for restraint. Councilor Trexel of the Diplomatic Legion, projected his voice to be heard over the din.
"While vengeance may assuage our wounded pride, it will not ensure our continued survival. Rushing headlong into battle, could spell the end of our species."
As tensions threatened to boil over, the Emperor raised his hands, and the chamber slowly fell back into an uncomfortable silence. "My friends, in these dark times, we must come together with clear heads, not tear each other apart. Councilor Trexel speaks wisdom, we know little of our new enemies, and acted rashly before. Another hasty demand on humans, could seal our doom."
Senator Vortok spat in disgust. "For generations, we have expanded the borders of our glorious empire, through strength of arms! Now you preach cowardice, and appeasement?"
The Emperor turned to face him directly, his eyes narrowing. "I preach nothing but caution, which has always guided our people through countless wars, and plagues. Would you risk intergalactic war, to soothe your damaged pride? There is too much at stake."
The Emperor's sober words hung heavy in the air, as discussion stirred once more, among the assembled senators. Councilor Trexel spoke up, to address Senator Vortok's outburst.
"Strength alone will not assure victory in this new conflict. These humans overwhelmed Ambassador Grax's fleet, with technology far beyond our own. We know little of their world, their numbers, or their true capabilities. Charging in blind would be the height of foolishness. I say we devote our shipyards to rebuilding our fleet, while spies learn what they can of this race."
"Reconnoiter and rebuild?" scoffed Vortok. "You coddle our warriors with hesitation and fear. Our fleet was taken unawares, next time it will be different. Double our forces and sweep across the frontier. Teach these upstarts the price of defiance."
Trexel shook his head solemnly. "Even doubled, our forces mean nothing, if we do not counter whatever advantage felled Grax. We must understand our enemy, before engaging them at full scale,, or risk obliteration."
Admiral Korfax, commander of the Vraxian fleets, spoke up in support of Trexel. "As the one, tasked with leading our warriors into battle, I say caution is warranted. Superior numbers alone, will not undo an enemy, capable of such devastation. Give me time to analyze the battle and reports, to glean some insight into their tactics and technologies. Only then, can we craft a prudent strategy."
Senator Zornak of the imperial ministry interjected, "And what of our citizens, while we cower in hiding? Word of this disaster will spread; morale and faith in our rule will falter. Inaction, will bleed us dry, as effectively as any foe. We must act, to restore confidence and control!"
Trexel turned to the Emperor. "Noble Zornak raises a fair point. While military strength is crucial, we cannot neglect the spirits of our people, and other species under our protection. I propose a show of resolution, bolster border defenses, reinforce outlying colonies, commission more warships. Let our subjects see we mean to secure our domain, while avoiding reckless attacks that risk further losses."
Vortok snarled in contempt. "Defensive posturing, and reactionary policies? You would have our empire a quivering coward, before these humans. We should meet them head-on, and break their will to fight, as our forebears did to all who opposed us!"
"Or drive them to desperation, where they unleash terror, we cannot imagine," countered Trexel. "The wars of old forged our domain, but brought untold suffering too. Must we court annihilation, to satisfy your thirst for blood?"
The debate raged on, with tensions rising between the militant and cautious factions. No consensus seemed within reach, as positions polarized. Then Admiral Korfax spoke again, his words cutting through the verbal melee.
"My lieutenants have analyzed the parts of the battle, and transmissions from Grax's final battle. The enemy utilized advanced plasma weapons, and shielding far more potent, than any technology we have, according to analyses. Furthermore..." He paused gravely. "Sensors detected over 200 warships orbiting their world, not big as one, that destroyed Grax's fleet. My analytics doesn't think, that those humans have more of the so called Dreadnought ships in orbit.
Murmurs erupted at this revelation. Even Zornak seemed taken aback, at the scale of the human numbers and strength. But they still have only one Dreadnought class ship; if they could disable it in any way, he wondered.
Korfax pressed on.
"I once advocated meeting force with force, but no amount of reinforcements, or bravado can overturn such a gulf. Councilor Trexel is right, we must pull back inside our borders, consolidate our forces, and learn all we can, how to counter, these humans on equal footing. Only then can we ensure victory, instead of futile sacrifice. Anything less could will see our domain, fall to this new power."
A hush fell over the chamber, as the full magnitude of the crisis, took hold. The Emperor rose, and regarded his divided court, with a grim expression.
"Admiral Korfax speaks the bitter truth we must accept, no matter the hurt to our pride. From this day, reconstruction and Intelligence become our highest priorities. All fleets are hereby recalled, to the border systems, for refit and rearmament. Councilor Trexel, the Diplomatic Corps is charged with gathering what information your spies, and envoys can obtain of our new enemy. Only with time, study, and a new approach, will we emerge from this darkness, with our empire intact."
A somber acceptance met his declaration. The Vraxian Empire faced its greatest test, and survival would demand, abandoning old assumptions. War remained an option, but prudence said victory lay down, a different path for now. The humans had thrown down a gauntlet, and the Vraxians' response, would shape their realm's destiny.
As the debate raged on, two young Vraxian warriors watched from the upper viewing balconies, reserved for guests and citizens. Sergeant Maknor gripped the railing tightly, his aged exoskeleton creaking under the pressure. "This Senate squabble will come to nothing. The humans have shamed us, and must answer for it in blood."
His companion, Lieutenant Fylox, was less certain. "And if more of their mighty war machines, stand between us? You saw the footage of the engagement, same as I. One destroyed hundreds, of our finest cruisers, in the span of hours."
Maknor rounded on him fiercely. "So we should cower, like trembling hatchlings, instead of restoring our honor? There are trillions of us, and we command the greatest fleets, the galaxy has ever seen. Numbers and courage will carry the day, as they always have!"
Fylox started to reply, but was cut off, by an eruption of cheers from below. It seemed the hardliners had gained ascendency once more. The Emperor's words of reason, were being drowned out, by collective grievance, and longing for vengeance. As the debate threatened, to boil over into open violence, it seemed war with the aliens from system of Sol, was becoming inevitable.

Killer Grips: Anne Maria, Brick, Jasmine, Justin, Millie
Screaming Gaffers: Chase, Izzy, MK, Ripper, Scott
Episode 8: One Flu Over the Cuckoos
"Last time, on Total Drama Action! Imprisoned in a world they didn't create. Forced to ingest deadly foods, and even to taste them twice!"
"Nonetheless, the two courageous teams clawed their way to freedom! And... a lonely Chef made a new friend."
"But prison is no place for law abiding citizens. Even athletic ones. So at the end of the day, it was goodbye, Sky, hello... Izzy?" The camera panned back to show Chris lounging in the control tent. "Yeah. Izzy. That girl is eight shades of nutty. Will she drive everyone else crazy too?"
The scene flashed to a close-up of Chris standing in front of the cast trailers, the camera pulling back with each word of the show's title. "Find out now, on Total! Drama! Action!"
(Theme Song)
The scene faded in to a shot of an owl hooting on a tree branch at night until a few sparks erupted from it and its head popped off on a spring. The camera panned down and to the left, catching the castmates as they made their way back to their trailers; the Gaffers were in front, and the Grips were in the back, though Brick was noticeably absent.
“Everything is so much smaller than I remembered!” Izzy said while looking around.
"I can't believe that you guys eliminated Sky," Chase said as the camera focused on the Gaffers. "She would have continued to help carry us to victory if she was still here."
“I remember that bush! I remember that tree!” Izzy continued to observe her surroundings until she tripped onto the floor, only to get back up. “Oh, I remember that rock! Hey rock!”
“You know,” Scott spoke up, “with Sky gone and Izzy being back, it's like we didn't lose a player.”
“That may be because the teams are still evenly matched,” MK claimed.
"Good night everybody," Millie told the contestants in a tired tone as she took the steps up to the girls' trailer. "I really need to get some rest." She grabbed the door handle and habitually moved to open it, but it didn't budge and she slammed face-first into it.
"First they lock us in," Ripper said as the camera cut over to him pulling on the door handle of the guys' trailer, "and now they're locking us out!" He grunted as he kept trying to open it, but he failed to move it at all.
"Wait, wait," Izzy said from off-screen, "let me try it!" Ripper quickly stepped aside just as Izzy rammed the door and bounced off of it without making a dent.
A loud siren started up as tense music began to play in the background.
“Cops!!!” Izzy panicked soon after getting up and ducked out of the way.
Seconds later, an ambulance drove past, stopping in front of them just long enough for the back doors to open and a covered stretcher to fall out. Siren still blaring, the ambulance drove off and the castmates hesitantly approached its former cargo.
"What is that? A dead body?" Anne Maria asked nervously.
"Or an undead body," Ripper guessed.
Whatever was on the stretcher sat up, and the cover fell away to reveal Chris McLean lying on a colorful stack of books. The castmates gasped and murmured at the dazed-looking host. "...Boo!" the handsome man said suddenly, earning a blank look from MK.
The host then cleared his throat. "Calm yourselves. No one's dead yet," he said with a smile, holding up one of the books. "I'm here to prep you plucky ducks for our most awesome challenge yet! These textbooks hold the sum total of eight years of med school, and each one of you gets one," he explained before tossing the book in his hand to Anne Maria who raised an eyebrow once she caught it, "cause tomorrow, we're gonna play Doctor!" A few deep and tense notes played as Anne Maria rolled her eyes.
Confessional: Anne Maria
"I don't have anything against doctors," Anne Maria confessed. "It is their job to put scalpers and needles onto people, and give advice like “Don't break your leg because you were out late skateboarding,” but playing doctor isn't really in my wheelhouse.”
Confessional: Brick
"If I wanted to, I could be a doctor," Brick explained to the camera. "I've been to the doctor's office countless times because of my many injuries, like a twisted wrist, a joint thumb, bruised ribs, or even my leg getting bit by a dog." He shuddered. “Don't ask. But the military is my top priority.”
Confessionals End
"To win this challenge," Chris said as the footage cut back to him and the castmates, each of whom now held a textbook, "you're gonna want to memorize the entire contents of these textbooks. By morning."
"But it's already late," Millie protested.
"You got that right," Chris answered as a golf cart drove up with a giant pizza slice on the roof and a large stack of pizza boxes in the back. The driver was Chef, who had a pizza delivery hat on. As soon as the cart stopped, Chef got out and carried the comically large stack of pizzas over to Chase. "What med school all-nighter would be complete without pizza?" Chris asked.
Chase was shown dropping his textbook as he accepted the stack in awe, and a harp played in the background as he and Izzy gave it a sniff. He let out an approving sigh as Izzy smiled happily. "Pizza," the daredevil said.
"This has to be a trick," Millie said.
"More like method acting," Chris told them as he walked over to the golf cart and hopped onto the back. "Med school interns consume 850% more pizza than the average human. So, dig in! Cause there's plenty more where that came from!" The cart sputtered away, leaving the castmates by themselves.
Jasmine opened the top box and took out a slice. "Looks okay, smells okay," she said before finally taking a bite. "Tastes...great!"
"How is that even possible?" Anne Maria asked.
The scene flashed over to an unfinished pizza getting tossed into the air, the camera following it as it fell into Brick's hands. The table he was standing at already had four other pizzas on it, and they looked to be complete.
The camera panned right over to Chef with four cooked pizzas at his table as he held a can of parmesan. "Keep 'em comin'," Chef ordered. "I'll add the final cheesy touch," he said deviously while sprinkling the can on one of the pizzas.
"I'm pretty sure my team is going to question where I am," Brick complained.
"Not as long as they're eating, they won't!" Chef got up in Brick's face. "So hush up and spin that dough. Spin like the wind." As Chef went back to his station, the camera zoomed in on Brick's worried face.
The scene flashed to the five Gaffers sitting in chairs by a fire in front of the cast trailers, eating pizza and reading textbooks. The camera focused in on Izzy and Ripper, who were in the two leftmost seats.
"Y'know," Ripper said, "one time me and my brothers ordered ten boxes of pizza in order to see who can eat the most without using their hands." He chuckled. “You should've been there watching us splatter sauce on each other.”
“Let's pretend I was!” Izzy tossed away her book. “Here!” She sprung off her chair, landed next to the pizza box in front of the team, and began to scarf on the pizza without using her hands.
“My three brothers would be jealous to see you do this quicker than them,” Ripper commented.
Grabbing a pizza with her teeth, Izzy started to shake it around like a rabid animal, splattering sauce onto everybody.
“My hat!” MK exclaimed.
“My shirt!” Scott shouted.
“My pizza!” Chase cried out dramatically.
Confessional: Izzy
“I am so glad to be back,” Izzy said. “I was top of my pre-med class before the RCMP started chasing me, so this should be a snap! On the other hand, I'll tone down my impressions since it bothered Ripper the last time I was here, and he's my friend so I'll try to put his feelings into consideration.”
Confessional: Ripper
“It's amazing that Izzy is back in the game, and unlike the first time it happened, I'm around to witness it,” Ripper chimed. “She better not make us call her E-Scope though. That was really bugging me out.”
Confessionals End
The scene moved to the inside of the craft services tent, where four of the Killer Grips were studying at one of the tables. Millie and Anne Maria were on one side of the table, with Justin opposite them and Jasmine standing away from them.
Justin noticed Jasmine's unhappy expression and decided to go over and press the matter. “Is something wrong?” the eye candy asked.
Jasmine was startled by the question and regained her composure. “I'm completely fine. Nothing's bringing me down.”
“Just tell me. I don't blab about secrets,” Justin continued.
“If you must know, Brick's been spending less time with us lately,” Jasmine confessed. “Usually before the challenge, we never even see him.”
“I've noticed as well,” Justin nodded. “And this is bringing you down because?”
“Me and him have a special bond going, and it may lead into something more than that, but how are we supposed to know each other more if he's avoiding us?” Jasmine wondered.
“Brick'll probably explain what's going on to us, but don't badger him,” Justin advised. “It'll most likely cause him to lie.”
“That's a good idea. If there's one thing I do not like, it's when someone is lying to me,” Jasmine admitted.
“Interesting…” Justin mused to himself.
Confessional: Justin
“Jasmine's concern plus Brick's disappearances equals an opportunity for me to cause a little bit of turmoil between them,” Justin calculated. “That way, I could get one of them eliminated with Anne Maria and Millie's help.”
Confessional Ends
"Man, is this pizza delicious or what?" Anne Maria said as she took a bite out of the slice she was holding. "I wish Chef could cook more food like this for us every day."
Jasmine took a bite of her slice and saw Millie focused on reading rather than eating. "Are you not going to nibble at least one slice, Millie?"
Millie looked up from the book she'd been studying and blinked.
Confessional: Millie
"With the challenge that we're going to get, I have to focus on studying all the contexts of that textbook so I won't forget a single detail," Millie told the camera. "And plus, I'm not really a big fan of pizza."
Confessional Ends
A close-up of an open pizza box was shown as Justin reached in to grab one of the last remaining pieces. "If you don't want any pizza, then that means there's more for us," he said.
“Hold on. Brick hasn't had any,” Jasmine interrupted.
"Where is he anyway?" Anne Maria asked.
Brick then peeked out of the counter, and he ducked down, crawled under the table, and popped up in order to act like he just arrived. "Sorry I'm late. I had an urgent bathroom emergency," he said.
"Here's your pizza," Jasmine slid the open box to the end of the table.
Brick picked up a slice, took a bite, and smiled as he chewed it. "My cooking skills are great!"
"I'm stuffed," Anne Maria said as she stood up. "And with tomorrow being a reward challenge and all, I can just go back to my trailer. Good night!" She began to leave.
"I study better when I'm by myself. Nothing personal," Millie told the team and left the tent as well.
Confessional: Jasmine
"I could make them stay," Jasmine said in the make-up trailer, "but there's no point in doing so. Millie is already educated enough to not read the textbook, and Anne Maria is as tough as an untamed crocodile when it comes to talking with her."
Confessional Ends
The scene moved to Anne Maria and Millie as they walked through the film lot to get to their trailer.
"I thought you'd still be studying back at the tent," Anne Maria casted a suspicious look at her teammate. “Why are you following me?”
"I still want to read the textbook. I just want to do it someplace quiet," Millie replied. “What about you?”
“Like I said, I'm going to sleep,” Anne Maria said. “There's no need to give it my all if the challenge won't have an elimination.”
“You may be wrong about that. Chris is very unpredictable when it comes to episodes having eliminations or not,” Millie argued. “Did you at least read some pages of the textbook?”
“Yeah, and I don't want my head to be egg headed like yours is, brainiac,” Anne Maria claimed.
This got a glare from Millie. “Hey, just because I'm smart, doesn't mean I don't have any more depth to me,” the writer scolded.
“If all we're gonna do is argue, then let's keep to ourselves for the rest of the night,” Anne Maria rebutted.
“That's fine by me,” Millie agreed with the tanned girl.
The scene faded forward into a shot of the numbered studios the following day. The camera cut inside, showing the ten castmates lined up in a small room facing a double door, all but Millie and Anne Maria looking exhausted.
"So tired," Jasmine groaned.
"My brain has never been this full," Ripper mumbled.
"You guys should've turned in for the night like I did if you didn't wanna look like zombies," Anne Maria stated, making the others groan at her.
"Morning, competitors!" Chris said in a chipper tone as he slid in through the door. "Or should I say...DOCTORS!" He pulled out a large gun from behind his back, eliciting a gasp from the teens as he pointed it at them. He fired it at them starting with the Gaffers, and the camera focused on Izzy and Scott at the far end of the line as stethoscopes and reflector headband landed on them. Chase, MK, and Ripper were the next to get hit and MK fell to the ground after impact. Brick and Millie followed, then Anne Maria, Jasmine, and Justin.
"Ready for today's big challenge?" Chris asked them with a smile.
“We pulled an all-nighter studying for this," Scott grunted. "Why wouldn't we all be?"
"If only teenagers were as dedicated to their studies as you guys are!" Chris said with a light laugh. "Let's take it inside." He started backing into the room he'd come out of, the castmates following after him.
The camera cut to a close-up of a large compound stage light before zooming out to show the cast assembled in a large room, each team standing by a large green vat of bubbling slime, a ladder leading up to a high dive, and a sort of slanted platform with a person-shaped indent in it.
"Today's challenge is called," Chris said as the background music became low and tense, "Visiting Hours. And only one member of the winning team will get to enjoy the reward." A few drum beats played, and the camera panned over to the Grips on the left.
"Hold up," Anne Maria asked. "Why're we doing this in teams if only one of us gets to win?"
"I guess it's one for all and all for one this time," Jasmine said.
"But who gets to be the one?" Brick wondered aloud.
"Let's leave it to the one who contributes the most," Millie told them.
Confessional: Millie
"Which will likely be me," Millie added in the confessional trailer.
Confessional Ends
"So what is the reward, Chris?" Chase asked.
"You're very perceptive, Chase," Chris told him. "Let's see if that helps you and your team assemble a CADAVER!" A game show jingle played as he made the announcement.
"You're talking about a dead body, right?" Izzy asked.
"No," Chris corrected as the game show jingle played again, "I'm talking about a giant dead body!" The shot zoomed out further than it had before, revealing that the slanted platforms were attached to chains leading up to a reel in the ceiling and two strange devices on mounted either side just below.
"These tanks contain the dismembered parts of two identical cadavers," he explained over an elevator music-like tune. "Each player will climb their respective team ladder, strap on the bungee cord," the shot cut from his close-up to a bungee harness dangling in front of the Gaffers' diving board, "and jump into the tank with hopes of retrieving a body part." The camera panned down to the tank, then over to the slanted platform. "Any parts you find will be snapped in place on the platforms. Use those chains to raise them all the way to the roof," he continued as the camera followed the chain up to the strange device on either side of the gap in the ceiling as a jolt of electricity stream between them, "where they'll be reanimated by a blast of lightning!"
"First team to bring a Franken-Chris back to life wins," the host told them. "First crack goes to the team who can tell me how to treat someone with a bean stuck up their nose." He tapped his nose, and the camera panned over to the Gaffers.
MK was the first to open her mouth. "Administer two ccs of pain meds and probe the affected area with a sterile swab."
"Correctomundo!" Chris said, giving her a pair of finger pistols.
"Yes!" MK cheered.
The footage flashed forward to the AV girl on top of her team's diving board, the bungee harness already secured. She jumped off with a scream and plunged into the vat, popping back up a moment later as she was electrocuted by the electric eel she was now holding. She let the fish go at the peak of her trip back up, and grabbed on to the edge of the diving board. "What the heck was that?!" she asked in shock.
"Oh yeah," Chris said, "I forgot to mention the electric eels. Three zaps for each turn and you're out!"
With a hesitant look on her face, MK allowed herself to drop back into the vat. She emerged holding a grayish and slime-covered leg. "Got it!" she called as the camera cut to Ripper who was standing by the Gaffers' platform with his arms out to catch. He caught the limb, then turned around and fit it into place.
"Okay, next question!" Chris announced. "Your patient has an itchy red inflammation on their butt! Diagnosis?"
"Diaper rash," Brick spoke up first. "Apply salve repeatedly to achieve humectant dispersion."
"Yes!" Chris said, and Brick smiled.
The footage cut forward to him diving off the board and into the vat. He sprung back out holding an eel, and it shocked him. "Sorry!" he said before plunging back down. He came back up a second time, now holding two eels. "Sorry again!" he told them, falling once more after getting shocked. He popped out holding a hand, which he quickly tossed to his team.
"Don't let it touch my hair!" Justin fumbled with the hand a few times before tossing it over to Jasmine, who rolled her eyes and put it in the right-hand slot.
"Next question!" Chris said. "Your patient's got a white tongue, red eyes, and they're oozing gooey crud! Diagnosis?"
"If I'm not wrong, that should be Pinkus Eyeicus," Chase answered. "Treat with two rounds of floppity jibbits."
"Absolutely correct!" Chris told him. The camera zoomed in on him as he slyly added "I messed around with some of the terms in the textbook."
Chase looked down at the vat, then jumped. He fell without a sound, but when he came back up with an eel in each hand, he shrieked and got electrocuted. He plunged back down, and this time came up with another leg. "Hey, I got one this time!" he said with a smile before tossing the limb over to Scott.
Scott jumped for it, then turned around and slammed it into place.
"Smells like ear wax?" Chris asked next, rushing up to Jasmine with a grin on his face.
"Pineapple-itis," Jasmine answered before low-fiving the host.
Jasmine was shown jumping down, and sprung back up to diving board-level seconds later with three eels on her body; she screamed as she was shocked.
"Fur between the toes?" Chris asked, bending down to point at his bare feet, one of which had a tuft of brown hair growing out of it.
"Stick two horse feathers up the whizzbang!" Izzy answered when the host turned to her.
Izzy was shown dropping into the vat and coming back up with a torso and a smile on her face.
A montage of parts getting added was shown next. Millie was first, putting a leg into her team's platform. Second was Chase, slotting one of his team's arms in. Brick added a waist for the Grips, and the clips transitioned to other parts of the challenge.
"Waka-waka two-by-four!" Scott answered.
Anne Maria was shown listening to Chris's chest with her stethoscope before enthusiastically saying "Sissypants McGee!" to the host's brief approval and sudden discomfort.
Ripper was shown trying to strangle one of the eels as it shocked him, then Justin was shown being electrocuted thrice by the eels before eventually holding up a Chris head. He tossed it to Anne Maria, who was sitting on Jasmine's shoulders, and the two turned around to put the piece in – all they were missing now was the left arm and hand.
"The Grips ahead by...a head!" Chris announced, the camera cutting over to the Gaffers' platform and the five teens giving it nervous, annoyed, and uncertain looks – aside from the head, all they were missing was the right arm and hand.
"Alright Gaffers, next question!" the host said as he slid over to the other team. "Your patient's feeling tired, has spongy gums, and a bunch of spots on their thighs. Diagnosis?"
"Scurvy," Ripper said. "Treated with an increase of dietary vitamin C."
"Correct!" Chris announced excitedly.
The footage cut forward, focusing on the Gaffers' vat as Ripper dived into it. He emerged moments later with his team's hand, and threw it over to Izzy who quickly put it into place.
Confessional: Ripper
“I'm not sure if what we studied are actually real life symptoms and diagnoses, but who am I to know?” Ripper shrugged uncaringly. “I'm not one to study for this sort of stuff unless there's a million dollars on the line.”
Confessional Ends
Another skip forward showed Millie plunging into the vat and coming back out with the arm. "Alright, last piece coming your way!" she said excitedly before tossing it to her off-screen teammates.
It was Justin who caught the piece and put it into the only remaining indentation on the platform. "The Grips have their cadaver!" Chris announced in a close-up. "Time to start yanking some chain, and be quick about it 'cause the Gaffers are right behind you!"
Jasmine and Brick began to pull on their team's chain while Anne Maria moved the slanted scaffold out from under the platform and Justin and Millie watched in anticipation as the cadaver-containing platform was rising quickly.
The camera cut over to the Gaffers as Izzy dangled from the bungee harness covered in slime. “I got it! I got it!” She tossed the Chris head over to MK.
MK stopped in front of the platform and drew back her arm, tossing it up to Chase who had climbed the back of the platform in preparation. The daredevil caught it and slotted the part in, then dropped to the ground.
"Now we pull!" MK ordered as Chase joined Ripper and Scott at the chain.
"Heave!" Ripper said as the three started to pull in rhythm. "Ho! Heave!"
"The Gaffers are still in this," Chris told the camera in a close-up. "Whose cadaver will hit the roof first?" he asked with a shrug. "Make sure you come back for all the Total! Drama! Action!" he finished excitedly.
(Commercial Break)

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.

Hi! I have been diagnosed with scabies 3 weeks ago. I had two rounds of pemethrin treatment a week apart (so my last treatemnt was a week ago) I also got a steroid cream to help the rash desappear and treat post scabies. My rash did got better but I am paranoid that only the steroid cream eased my symptoms. I’m still seeing burrows and each one of them have a little black dot at the end. I picked out every one of these black things I could out find and there were a lot, I picked out at least 50. You can clearly see some them moving in the attached video. Are these the mites? Does this mean that the treatment didn’t work? Please help if you experienced something similar, I’m so scared that I’m still contagious!

Imagine waking up one day to discover a smooth, round bald spot on your head. It’s not just a bad hair day; it’s alopecia areata — a condition affecting millions worldwide. But what exactly is alopecia areata, and how does it unfold? Let’s look into the intricate web of symptoms, causes, and treatments that define this mysterious condition.

Decode the Symptoms

Alopecia areata can come out of nowhere, usually affecting hair follicles but sometimes involving nail beds too. At the outset, it shows up as round or oval patches of hair loss on the scalp, leaving behind bare spots without any signs of rash or redness. Some folks even feel tingling, burning, or itching sensations before the hair starts to fall out.
As the condition progresses, the story unfolds in different ways. Hair may regrow within months, offering hope amidst the barren patches, or new patches may emerge, expanding the canvas of hair loss. In rare cases, it evolves into more severe forms — alopecia totalis and alopecia universalis — where hair loss extends to the entire scalp and body.

Decoding the Symptoms

Beyond what you can see, there are more subtle clues, like itching, changes in colour, and unusual hairs — thicker at the top, narrowing like an exclamation mark — that give a clear picture of how the disease is moving forward. In the middle of all the not-knowing, there’s a pattern. Hair grows, then it falls out again, and it can feel like a ride with ups and downs — moments of hope and moments of feeling let down.

A Visual Journey Through Alopecia Areata

Looking at pictures helps you see what people with alopecia areata go through. Each picture — from when they first lose a patch of hair to when they lose a lot — shows how strong they are. The loss of eyebrows, eyelashes, and body hair marks pivotal moments, showing just how deeply this condition can affect someone’s sense of self.

The Mystery Behind Alopecia Areata

What sets off this autoimmune reaction, causing the body to turn against its follicles? Alopecia areata is like solving a puzzle with many pieces. It involves your genes, environmental factors, and sometimes just chance. But it’s not just about what’s happening physically; it’s also about dealing with feelings and social challenges. It’s like walking through a maze where stress, worry, and feeling sad are all part of the journey.

Hope in Treatment and Management

Even though there’s a lot of uncertainty, there are rays of hope in different treatment avenues, ranging from corticosteroids to phototherapy. When regular treatments don’t work as well as we hope, getting creative with hairstyles can be a fantastic way to show off our unique style and beauty. It’s a reminder that even when we face challenges, we can still celebrate our individuality and look amazing doing it.

The Journey

Alopecia areata isn’t just a medical condition; it’s a journey filled with highs and lows, victories and challenges. It serves as a powerful reminder of the incredible resilience within each of us, the capacity to find beauty even amid chaos. To all those walking this path, remember: you’re not alone. Your story, your journey, is a testament to the strength of the human spirit — a masterpiece in its own right.
When it comes to managing alopecia areata, having a reliable ally can be a game-changer. That’s where Keva Hair Care steps in. With our deep knowledge of hair care and our commitment to tailor-made treatment strategies, we provide a ray of hope for individuals like me who are dealing with this condition.
For those ready to embark on a transformative journey to restore their crowning glory, Keva Hair Care awaits. With a promise of unparalleled excellence, it is the beacon of hope for many.
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Hi guys,
Need your help. Been going at this shit for years, haven't had much luck.
This is my current regiment for what I presume is predominantly a SIFO issue (and this is mostly about SIFO) and possibly some SIBO (hence the rifaximin). Some of the things I'm taking are just for general maintenance/continuation from prior or preexisting ailments. The interfase and now candida support are things I've already introduced to supplement the regime my doctor has given me as I'm not fully convinced by what she has currently advised for SIFO/SIBO. I also have kirkman biofilm defense and awaiting bp2a by priority one so that I can rotate/complement BDs. And finally, at the bottom are additional supplements I'm considering to add.
I treated SIBO before with a round of rifaximin 400mg followed by gi microbex. Been treating SIFO since. Did 2 months of fluco 50mg and SI complex (2x twice a day). Doc put me on a third month of fluco with rifaximin this time also (suspecting it could be either SIFO/SIBO or both seeing as I had little to no improvement). Taken me off SI complex until I finish the antimicrobial meds. Should have OAT results soon.
A lot of brain fog/cognitive impairment, a lot of emotional numbing, really whole spectrum of mental symptoms. Not much anxiety, if at all. Digestive issues, appetite, constipation (better since taking iberogast able to go more often than not), bloating 24/7, occasionally feeling full, fatigue, oral thrush nearly 24/7, rashes, chills, aches, a bit of respiratory, songs in head 24/7 just quiet and not there when im preoccupied, manual breathing (become conscious of my breathing routinely), muscle twitching/spasms, feel wired/electricity running through nervous system 24/7. I understand most but not all of this is necessarily from SIFO/SIBO alone.
Not sure how relevant but, treated dysbiosis in large intestine at the very beginning. Have stool results – GI mapping shows no candida in large intestine. Just had strep and entero faecium overgrowth, as well as enterobacter and klebsiella pneumonia overgrowth. A good amount of bifido. Not much lactoballis. And had slight clostridium overgrowth. Still in the process of eradicating marcons. Have had CIRS in the past but think that’s mostly resolved.
Regiment:
1/2 hr before anything Thyroid meds Xyclear + EDTA
Coffee enema
Interfase x2
FIRST MEAL Digestive enzymes x3/x4 SFM Xcell x1 Adrenotone x2 Milk thistle x1 Curcumin x1 Rifaximin x1 Candida support x2 Guanosine x1 Vit D x4 Iberogast
Walk FSB x1 + Molybdenum x1 Xyclear + EDTA
SECOND MEAL Digestive enzymes x3/x4 Fish oil x1/x2 Curcumin x1 Rifaximin x1 Fluconazole x1 Iberogast Vit C
BEFORE BEDTIME (P5P + Mg + 5HTP + GABA + DM) x3 LDN x1 Melatonin 1mg x2 Gastrodaily Xyclear + EDTA
BEDTIME Interfase x2
Sf722 (ready on standby) ginger extract? nystatin? SI complex (reintroduce now)? probiotic?
I hope its not convoluted. Any help is greatly appreciated.
Thank you.

Hi guys,
Need your help. Been going at this shit for years, haven't had much luck.
This is my current regiment for what I presume is predominantly a SIFO issue (and this is mostly about SIFO) and possibly some SIBO (hence the rifaximin). Some of the things I'm taking are just for general maintenance/continuation from prior or preexisting ailments. The interfase and now candida support are things I've already introduced to supplement the regime my doctor has given me as I'm not fully convinced by what she has currently advised for SIFO/SIBO. I have kirkman biofilm defense and awaiting bp2a by priority one so that I can rotate/complement BDs. And finally, at the bottom are additional supplements I'm considering to add.
I treated SIBO before with a round of rifaximin 400mg followed by gi microbex. Been treating SIFO since. Did 2 months of fluco 50mg and SI complex (2x twice a day). Doc put me on a third month of fluco with rifaximin this time also (suspecting it could be either SIFO/SIBO or both seeing as I had little to no improvement). Taken me off SI complex until I finish the antimicrobial meds.
A lot of brain fog/cognitive impairment, a lot of emotional numbing, really whole spectrum of mental symptoms. Not much anxiety, if at all. Digestive issues, appetite, constipation, bloating 24/7, occasionally feeling full, fatigue, oral thrush nearly 24/7, rashes, chills, aches, a bit of respiratory, songs in head 24/7, manual breathing, muscle twitching/spasms, feel wired/electricity running through nervous system 24/7.
Not sure how relevant but, treated dysbiosis in large intestine at the very beginning. Have stool results – GI mapping shows no candida in large intestine. Just had strep and entero faecium overgrowth, as well as enterobacter and klebsiella pneumonia overgrowth. A good amount of bifido. Not much lactoballis. And had slight clostridium overgrowth. Still in the process of eradicating marcons. Have had CIRS in the past but think that’s mostly resolved.
1/2 hr before anything Thyroid meds Xyclear + EDTA
Coffee enema
Interfase x2
FIRST MEAL Digestive enzymes x3/x4 SFM Xcell x1 Adrenotone x2 Milk thistle x1 Curcumin x1 Rifaximin x1 Candida support x2 Guanosine x1 Vit D x4 Iberogast
Walk FSB x1 + Molybdenum x1 Xyclear + EDTA
SECOND MEAL Digestive enzymes x3/x4 Fish oil x1/x2 Curcumin x1 Rifaximin x1 Fluconazole x1 Iberogast Vit C
BEFORE BEDTIME (P5P + Mg + 5HTP + GABA + DM) x3 LDN x1 Melatonin 1mg x2 Gastrodaily Xyclear + EDTA
BEDTIME Interfase x2
Sf722 (ready on standby) ginger extract? nystatin? SI complex (reintroduce now)? probiotic?
I hope its not convoluted. Any help is greatly appreciated.
Thank you.

Hi guys,
Need your help. Been going at this shit for years, haven't had much luck.
This is my current regiment for what I presume is predominantly a SIFO issue (and this is mostly about SIFO) and possibly some SIBO (hence the rifaximin). Some of the things I'm taking are just for general maintenance/continuation from prior or preexisting ailments. The interfase and now candida support are things I've already introduced to supplement the regime my doctor has given me as I'm not fully convinced by what she has currently advised for SIFO/SIBO. I also have kirkman biofilm defense and awaiting bp2a by priority one so that I can rotate/complement BDs. And finally, at the bottom are additional supplements I'm considering to add.
I treated SIBO before with a round of rifaximin 400mg followed by gi microbex. Been treating SIFO since. Did 2 months of fluco 50mg and SI complex (2x twice a day). Doc put me on a third month of fluco with rifaximin this time also (suspecting it could be either SIFO/SIBO or both seeing as I had little to no improvement). Taken me off SI complex until I finish the antimicrobial meds. Should have OAT results soon.
A lot of brain fog/cognitive impairment, a lot of emotional numbing, really whole spectrum of mental symptoms. Not much anxiety, if at all. Digestive issues, appetite, constipation (better since taking iberogast able to go more often than not), bloating 24/7, occasionally feeling full, fatigue, oral thrush nearly 24/7, rashes, chills, aches, a bit of respiratory, songs in head 24/7 just quiet and not there when im preoccupied, manual breathing (become conscious of my breathing routinely), muscle twitching/spasms, feel wired/electricity running through nervous system 24/7. I understand most but not all of this is necessarily from SIFO/SIBO alone.
Not sure how relevant but, treated dysbiosis in large intestine at the very beginning. Have stool results – GI mapping shows no candida in large intestine. Just had strep and entero faecium overgrowth, as well as enterobacter and klebsiella pneumonia overgrowth. A good amount of bifido. Not much lactoballis. And had slight clostridium overgrowth. Still in the process of eradicating marcons. Have had CIRS in the past but think that’s mostly resolved.
Regiment:
1/2 hr before anything Thyroid meds Xyclear + EDTA
Coffee enema
Interfase x2
FIRST MEAL Digestive enzymes x3/x4 SFM Xcell x1 Adrenotone x2 Milk thistle x1 Curcumin x1 Rifaximin x1 Candida support x2 Guanosine x1 Vit D x4 Iberogast
Walk FSB x1 + Molybdenum x1 Xyclear + EDTA
SECOND MEAL Digestive enzymes x3/x4 Fish oil x1/x2 Curcumin x1 Rifaximin x1 Fluconazole x1 Iberogast Vit C
BEFORE BEDTIME (P5P + Mg + 5HTP + GABA + DM) x3 LDN x1 Melatonin 1mg x2 Gastrodaily Xyclear + EDTA
BEDTIME Interfase x2
Sf722 (ready on standby) ginger extract? nystatin? SI complex (reintroduce now)? probiotic?
I hope its not convoluted. Any help is greatly appreciated.
Thank you.

I started feeling horrible piercing headaches four weeks ago, almost went to the ER, and was diagnosed with shingles within 3 days of first symptoms. On right side of scalp, forehead, cheek, down my neck a bit were all tender to the touch but no real rash ever appeared (that I could see or feel really). I was finally thinking the worst of this terrible nightmare was over and tonight the base of my scalp/neck felt irritated. I have a 3 in diameter area that is red and inflamed, tender. Unlike anything I’ve had so far. I’m panicking. Is it back? Is it leaving? Do I go back to the dr? I was just getting the gabapentin out of my system :(
Update: went to my GP who said it’s very uncommon for this to happen? Gave me a new round of medicine. Has this happened to anyone else?

Hi all. After a very long battle with a facial rash I have been positively diagnosed with discoid lupus (via biopsy). My bloodwork all looks good with no markers for SLE but I am still waiting for my initial evaluation with a rheumatologist next month. Im on my second round of steroid cream/Pimecrolumus cream as the lesions returned within a month of stopping last time. My Derm is pretty certain I’ll need to go on Plaquenil but we are waiting to see the Rheumatologist. As I await my appointment I’m finding myself getting more and more anxious. I know this isn’t the end of the world ( or my life) but I’m honestly scared. I’m afraid to take the PLAQUENIL as I’ve heard it can increase anxiety and also, I just don’t know what my life will look like going forward with this disease. Will I still be able to travel to see my grandkids? Go on trips? For reference, I Am 65 female with no previous history of illness or any autoimmune disorders. would appreciate hearing from those of you who are dealing with this and can maybe give me some feedback. Thanks.

CAUTION: LONG!
So this has happened to me once before (over a decade ago) and the whole ordeal seriously left me with PTSD. Back then, a vitamin recommended to me by a physio to treat a pinched nerve broke out what was great skin so I made the mistake of throwing all kinds of things at the issue. I learned my lesson and have kept a gentle, simple, natural routine ever since. My skin has been lovely, calm and clear as a result - even downright glowy and dewy.
Ironically, it was an oil for a recent ear infection (when antibiotics failed) which dribbled onto my skin that I believe must've done this. First, it gave me clogs which I only massaged a bit of jojoba oil into and I exfoliated twice in, oh gee, two weeks rather than my usual 4-6 weeks because, twice-over, I noticed some skin peeling in the area where the oil would land (I would wipe it and/or wash it off, but would awaken to find more had come out and onto my temporary (used a different one while this was going on) pillow so my skin was resting against that stuff for hours). I haven't taken an antibiotic for 9 or 10 years prior to this. Indeed, I always get a little stinging blotch by my right eye, on-off, for awhile after taking them and this time was no different. I'm wondering if they even messed with my skin's microbiota, contributing to this some and for what?! They didn't even cure the infection (which I thought could be viral since it lead on from a cold)! I understand there are barrier creams which contain probiotics/prebiotics and these interest me.
For said exfoliation, I always use ground oats mixed with a hydrosol or spring water which I then gently massage over my skin. This is what I have done for years and which a Garden of Wisdom skin consultant who worked with me back during the first round of an impaired skin barrier, okayed. I usually only do this every 4-6 weeks - sometimes going for longer, I'm just not a strong believer in exfoliating the skin on the face often, ironically.
So, last week, after the second exfoliation followed by my usual (gentle!) skin routine, my face flipped out within hours. I use no acids, no other actives, no alcohol-containing products or harsh, stripping cleansers. Hell, I don't even use masks anymore! I wear no makeup and my sunscreen for my face is a solid 50 SPF hat and a little raspberry seed oil.
I have sensitive skin - mostly normal - but it can be prone to clogs when it comes to heavier stuff. Last time my barrier got nuked, I was recommended a moisturizer with beeswax and I knew better than to use it but was desperate. I then paid with 60 clogged pores all over my face and neck which led to a summer of broken out skin while the mess purged. Since entering perimenopause (I'm 46), I've had perioral dermatitis rashes which I've learned to control and heal up, wholistically, within a day or two (they're also usually pretty mild). But, I know many of you are going to suggest I slather Vaseline or diaper cream on my face but with PD (which I'm more vulnerable to now with my messed up barrier), you can't use anything too occlusive and, frankly, I clog up and break out when it comes to heavy creams and ointments. Heck, even light ones can break me out which is why a combo of oil ( SIBU Sea Buckthorn Seed Oil)+ Avene Thermale Water spray +Caudalie Grape Water + hydrosol (helichrysum or frankincense) has worked so well for me for many, many years now.
My hydrosols sting and sometimes also the pure aloe vera gel I've cleansed my skin with for ages - even plain water does. My favorite faciil oil seems to be doing didley-squat to help this. I'm still using Avene and Caudalie (also has prebiotics) sprays because they mostly soothe it for a little bit. Do I just keep pushing on through the stinging (because most everything friggin' does!)?
Before and in being an herbalist, I made certain herbal concoctions and they were a huge saving grace then but now - they either soothe me or, alternatively and oddly, make my skin itch in my lower cheeks. I hadn't needed to be on one for 9 or 10 years prior to this. Indeed, I always get a little blotch by my right eye on-off for awhile after taking them.
Right now, I'm using products from Garden of Wisdom's soothing line plus their ceramides serum, but I just don''t know if they're helping or hurting. It's only been a week since I started that routine and they really seemed to soothe me for a couple of days but now, I think a couple items could be irritating me - not sure. They were suggested to me by their rep (who also suggested I use a product with tea tree and oregano oils for the zits I'm getting with this ordeal! Hell to the no! She also didn't steer me in the direction of their ceramides serum which some reviewers say healed their barriers, or another barrier-healing serum which I was considering, but I got another she suggested instead which I find sticky and possibly irritating).
I have an excellent whole foods diet, take certain skin-supportive nutrients (and have for years) and try and drink plenty of water every day. To make things even more complicated, I'm having hormonal night sweats which are, no, doubt, not helping this due to the loss of fluid. If I leave sweat on my face, I break out and here I'm trying to keep my face cleansing to one to two times a day (using just lukewarm water in the day, aloe vera gel or, occasionally the GoW cleanser at night). Normally, I go and give my face a quick rinse when this happens, but normally my moisture barrier isn't disrupted! I'm newly onto a wild yam cream which was a life-saver for me in my 20s so we will see how it works now.
I am open to not-so-natural things just to get this healed, but I'm not open to stuff that's just gonna leave me with other problems like multiple clogs, zits and PD flare-ups. I'm hearing just a simple, gentle cleanser (am highly allergic to sulfates! I also cannot do denatured and other drying alcohols!) and a good barrier cream might heal the compromised barrier in 2-12 weeks (and I'm already at 4, having had a few setbacks, unfortunately). Last time, it took far, far, far, FAR longer and my skin was reactive for quite some time afterward. I just don't have the patience for that, or the emotional/mental stamina to cope with it taking that long again. I'm really going to miss my hydrosols for however long this is going to take. Last time, helichyrsum soothed me so what the hell with this time?!
This ordeal has me in a lot of pain, distress and I'm mucho depressed as this is the 'straw that broke the camel's back' when it comes to my life at present. Frankly, my whole head is a mess at this point: chronic eye and ear issues (have ETD now since the infection now), the return of migraines after several years without, three lost dental fillings in the space of a few months and now my facial skin health is screwed!
With me, it's different because it's not like I need to pare things back since I normally have such a simple, gentle routine anyway. It's more like I still need a simple routine, but with certain added healing and soothing factors which are going to help, and get, my skin to recover, a.s.a.p. I've also thought of just using water to cleanse my skin with and spritzing with just some Avene - nothing else - and seeing how that goes for a couple of weeks. But I worry how my skin might feel in the process.
Thank you so much for any advice.

I was taking antibiotics and steroids for my sore throat during the beginning of mono, as I was dealing with tonsillitis as well. Once my steroid prescription was over I began developing a rash that started spreading rapidly. I went to ER and they said it was an antibiotic rash. They prescribed me a strong anti-histamine and another round of steroids. I'm so itchy, it's unbearable. I've been doing cold showers, calamine lotion, and ice packs. I don't even care how long the rash itself is there, I just want clarity on how long does the itchiness usually last? i can't sleep cus of it

Hey all, I’ve had a total of 4 rounds of permethrin - the second couple I took because honestly I was pretty paranoid, could feel the crawling and couldn’t stop itching my hand again.
Right now, I recently got some new bumps on my stomach. It’s pretty itchy but not scabies level where it’s urgent and you can’t stop itching. My best bet is on allergic dermatitis from the cream. I also get larger fluid filled bumps on my hands as well which stay there for a bit.
My question is, if I’m experiencing a body rash on thighs, chest, stomach, back, etc. but I am not really itching my hands or feet that much - is it simply my body reacting badly to the multiple doses I’ve had of the cream? Since my main cause of concern for reinfestation would be if my hands were extremely itchy.
P.S. my skins always been sensitive and I’ve had some bad times with eczema over the years.