Sorry this a bit of read, but I thought including the details might help someone else that could be caught in this crazy situation.
Brief background – we are currently AT&T customers and have 5 lines. The cost is getting crazy high (over $250/month) and the signal coverage is exceptionally horrible at both our main residence in NW Indiana and our cabin in norther Wisconsin.
We decide it is time to try a different service for a month and as we are heading up north on a family vacation in June and well see how the coverage and data speeds are. After some brief researching it looks like Visible is the one to try. I pickup an older unlocked Samsung S20 FE from Amazon so that we can do side by side comparisons. I confirm the IMEI works on the visible system and decide to just try the basic plan for 30 days.
5/24/2024 8:05pm – Placed the order (ending in 4668) for the basic plan. 10 minutes later I quickly realize, after I got the order confirmation, that I screwed up and didn’t use the referral code but put in the promotional code. ARGH!! I quickly contacted Visible support via chat and was connected to an agent in less than a minute. I was surprised how helpful the agent was as they immediately cancelled the order and told me that once I got an email confirming the cancellation I could go ahead and place the order again with the correct referral code. I was blown away by this level of quick support! (Unfortunately, that would be my LAST time of any positive feeling!)
5/24/2024 9:22pm – Received the cancellation email showing order ending in 4668 has been successfully cancelled.
5/24/2024 9:42pm – Place a new order (ending in 6667 – maybe the 666 should have been a sign?) with the correct referral code and all looks good. We receive an immediate confirmation email on the order ending in 6667.
5/25/2024 9:22am – Received a shipping confirmation email for order ending in 6667. WOW! At this point we are quite impressed with how well everything is going.
5/29/2024 1:20pm – In the mailbox is a UNSEALED, with the end completely open cardboard envelope with a new visible sim card and sim removal tool. However, there is NO other information or paperwork. Nothing! Just the sim card. Unfortunately had to work for the rest of the day so decided we would active the following day.
5/30/2024 – 12:20pm – Downloaded/installed the Visible app, installed the sim and proceeded to active it. Once activated I got a welcome email showing my phone number, but the phone would NOT connect to the Visible carrier network. Frustrated, I followed all the steps provided by the automated chatbot, but nothing worked, so I was connected with an agent. This is where everything started going off the rails! The agent told me that the sim I received was from the CANCELLED order! Please note the ONLY shipping email we received was for the 2^nd order ending in 6667. Since that was the only sim that was shipped, why wouldn’t we assume it was correct and try to activate it. Additionally, please remember that this was NO paperwork at all included with the sim. The agent tells us not to worry as the correct sim would be there that afternoon or the following day. However, when we login to our account and look at orders, it is showing that it will ship soon? Trusting the agent, we have patience. Nothing more comes that day.
5/31/2024 – 1:15pm – Mail gets delivered and NO sim! Now I am starting to get frustrated as we are scheduled to leave on the family vacation Saturday morning at 6am. Jump on the support chat and get connected to an agent. The agent takes quite a long time reviewing the situation and confirms that the 2^nd order, the order that was NOT cancelled, never shipped. I explain that we received the other sim and asked if they could just provision that one. The agent asked for the number, we sent it, but the agent said they could not reactivate a cancelled sim?? I kept pressing for how we can get this fixed, and the agent shocked me by asking if he could call me! He called me on my home phone line and explained that he was working to get everything corrected. I explained that we were scheduled to leave on our family vacation the following morning at 6am and we would be up north for the whole month of June. The agent asked if we can get mail at our cabin, but I explained that we don’t have US Mail service, but we can get UPS or FedEx deliveries. He said that they cannot ship with anything but USPS! He put me on hold and came back with a shocking solution. He would guarantee that he would ship the sim, via USPS, and have it to our Indiana address by Saturday using USPS. I told him that if was 100% certain of that next day delivery, we would postpone our departure by a day in order to get the delivery. He assured me and told me I would get a confirmation email shortly.
5/31/2024 – 5:11PM – Receive a shipping confirmation email, but when we click on the tracking link, it shows it is being shipped by FedEx and won’t be delivered until MONDAY!! What??!! Try to log in to get to chat, but the system has activated 2FA and wants to send a security code to the phone number that is NOT yet activated since I don’t have a sim!! Using the Visible app on my tablet, I am able to get to chat and get connected with an agent. This agent is FAR less helpful and basically tells me there is nothing they can do since I activated the wrong sim!!?? I explained again that I only tried to activate what they sent me. I requested that they change the activation status to “Not Activated” but the agent said they are not able to do this. The agent suggested that I can wait 48 hours post activation and then make a request to cancel everything and ask for a full refund. The agent said the earliest that request could be don’t was Saturday afternoon. Now we are EXTREMELY frustrated and just want OUT of this mess. The agent did provide a case number for the next agent to reference so we didn’t have start from scratch explaining everything.
6/1/2024 – 3:26pm – Was able to login by letting the system fail at sending the code to the non-active phone, and then using “another way” and having it send the code to my email. Started chat and got connected to an agent. Provided the case number and explained that we have two options: 1. Cancel everything and provide us a full refund or 2. Use FedEx or UPS to send us the correct sim to our cabin in northern Wisconsin as we do NOT have US Mail service and that cannot be an option. The agent said they don’t have control over what shipper is used but they could put a note on the order? We were told in order to make this happen we would need to change the billing/shipping address on our account. We quickly entered the correct address, but when we tried to save it, the system again wants to verify by sending a text to the non-activated phone number. However, this time there is no “another way” so we are completely stuck. We explain this situation to the agent and were told that they will need to escalate this. The agent understood our frustration but “guaranteed” that the address issue would be fixed within 1-2 hours and we would receive an email. Once that occurred, we would need to again contact support and request that they overnight a new sim to the new address (if it gets changed).
6/1/2024 – 7:15pm – (please note that this is WAY more than 1-2 hours) We still have not received any email, so again, I use the chat and get connected to an agent. I provide the case number and the agent quickly sees that it has been way more than 1-2 hours and commits to escalate it with “urgency”. The agent says that this will ensure that the issue is resolved in 1 hour. I explain that we barely have 1 hours’ worth of patience left but will look forward to the resolution in an hour! I did ask if it would just be easier to cancel EVERYTHING out of the system, issue us a refund and let us start over with a fresh new order. The agent said that this would cause issue with the current escalation??
6/1/2024 – 9:35pm – As you may have guessed…still NOTHING from Visible. We cannot change anything or start over since the system thinks we already have an activated sim and working phone but we DON’T. This is beyond absurd and just INSANE!! I had such high hopes and I fully understood that the cost structure allows a more limited support venue, but this is NUTS! How can you keep customers when you cannot even get them setup correctly, and when your system causes issues, how can you not provide your support team the tools and resources to quickly get them corrected?? I am not sure what our next steps should be but after requesting a supervisor, manager or team leader at every chat session, the standard response is “I am sorry but they are not currently available”! How does anything get done at Visible??!! I am a VP of Solutions Engineering and I couldn’t screw up a system this bad if I had my whole team focused on it!
Thanks for letting me vent and ramble, but I would be cautious about signing up with Visible. If things change and get quickly corrected, I will be the first to give kudos and update this here, but maybe we are just in a unique loophole situation that others don’t face?? Either way, I cannot remember the last time my frustration and blood pressure were elevated to this level.

The Collect
O God, your never-failing providence sets in order all things both in heaven and earth: Put away from us, we entreat you, all hurtful things, and give us those things which are profitable for us; through Jesus Christ our Lord, who lives and reigns with you and the Holy Spirit, one God, for ever and ever. Amen.
The Gospel
Mark 2:23–3:6
3:23 And it came to pass, that he went through the corn fields on the sabbath day; and his disciples began, as they went, to pluck the ears of corn.
24 And the Pharisees said unto him, Behold, why do they on the sabbath day that which is not lawful
25 And he said unto them, Have ye never read what David did, when he had need, and was an hungred, he, and they that were with him?
26 How he went into the house of God in the days of Abiathar the high priest, and did eat the shewbread, which is not lawful to eat but for the priests, and gave also to them which were with him?
27 And he said unto them, The sabbath was made for man, and not man for the sabbath:
28 Therefore the Son of man is Lord also of the sabbath
3 And he entered again into the synagogue; and there was a man there which had a withered hand.
2 And they watched him, whether he would heal him on the sabbath day; that they might accuse him.
3 And he saith unto the man which had the withered hand, Stand forth.
4 And he saith unto them, Is it lawful to do good on the sabbath days, or to do evil? to save life, or to kill? But they held their peace.
5 And when he had looked round about on them with anger, being grieved for the hardness of their hearts, he saith unto the man, Stretch forth thine hand. And he stretched it out: and his hand was restored whole as the other.
6 And the Pharisees went forth, and straightway took counsel with the Herodians against him, how they might destroy him.
Commentary on Today’s Gospel Selection;
One thing you can say about Mark, of the Gospel writers, he is the one who doesn’t mess around but goes to the heart of the matter; if Mark was writing about food, he would skip over the appetizers and go right to the main course. Here at the beginning of his Gospel he has grouped stories of Christ’s ministry that establish the God given authority of Jesus, and sotries that introduce the antagonism of the scribes, Pharisees, and Herodians—antagonism that will eventually lead to Jesus’ death on the cross.
We begin with a story of Jesus and the disciples traveling, on the Sabbath day, walking from village to village preaching the good news and Jesus healing the sick, and the disciples being hungry they begin to gather grain with their hands to eat.
The law of Moses allows for the hungry to gather grain, or even grapes for the purpose of immediately satisfying hunger, by hand on the Sabbath but not with implements or to put the produce up for later use. (see Deuteronomy 23:25) But here we find the detractors of Jesus trying to point blame at him for not teaching his disciples to observe the laws regarding labor on the Holy day. They contend that performing any work, even to satisfy one’s own hunger, violates the laws found in the Torah.
Assuming our modern day translations are correct, Deuteronomy 5:12-15 obviously bans performing routine labor on the Sabbath day, even the servants are to have a day of rest.
At issue here is what constitutes work. Is it work to pluck grain to satisfy one’s hunger? While various Old Testament passages deal with the subject of work (Exodus 16:22-30; 34:21; 35:2-3; Numbers 15:32-36; Nehemiah 10:31; 13:15-22; Jeremiah 17:21-22), they leave much to the imagination when it comes to defining exactly what constitutes work in particular situations.
However, Exodus 34:21 says, “Six days you shall work, but on the seventh day you shall rest: in plowing time and in harvest you shall rest”—so plowing and harvesting are clearly among the proscribed activities. The scribes list reaping as third among the 39 types of activities that they classify as work. The immediate question is not whether reaping is prohibited, then, because it clearly is. The question is whether plucking a few handfuls of grain constitutes reaping.
But of all God’s creation, he gave humans common sense and expects us to make use of it. If your house caught on fire during the Sabbath day, would you not and try to get as many of your possessions out which would in effect be labor? Would you expect the fire department to come put the fire out or would you not want the firemen to “labor” on the Sabbath day?
However, as often happens when people devote themselves to a narrow, intensive enterprise, their study took on a life of its own. By Jesus’ time, a substantial amount of scribal interpretation had been codified into the Mishnah (the Talmud, an extension of these studies, would come later).
Two problems resulted.
[1] Jewish religious leaders began to regard the Mishnah as second in importance only to the Torah—or even as equal to the Torah. It became increasingly difficult for them to differentiate between the Torah (God’s law) and the Mishnah (their interpretation of God’s law)—and they became increasingly inflexible in the application of their interpretations.
[2] As so often happens with academic endeavors, the scribes became so preoccupied with the fine points of the law that they lost the main point. We will see that in these verses as they criticize Jesus for allowing his disciples to pluck small amounts of grain on the sabbath (2:24)—and as they watch Jesus “to see whether he would cure (the man with the withered hand) on the sabbath, so that they might accuse him” (3:2).
At the core of the contention between the religious leaders and Jesus, is Jesus’ adherence to the intentions of his Father, God in heaven, and the religious leader’s inflexible application of their interpretations of God’s commands. It comes down to; “God’s way or their way.”
Jesus asked them: “Have ye never read what David did, when he had need, and was an hungred, he, and they that were with him?”
David was Israel's greatest (earthly) King, and by the time of Jesus, King David enjoyed an iconic status. Under his reign Israel and its people enjoyed the greatest days of glory, so much so that each and everyone of them were eagerly anticipating the prophesied return of the king, the Messiah, the anointed one who would return Israel to its former glory. Here we find Jesus, in his infinite wisdom demonstrating that the actions of his disciples parallel that of David’s actions, doing so will present his opponents with an irrefutable argument. He begins by stating that David and his companions were hungry—an obvious parallel to Jesus’ disciples.
“How he went into the house of God in the days of Abiathar the high priest, and did eat the shewbread, which is not lawful to eat but for the priests, and gave also to them which were with him?” Mark mistakenly uses Abiathar’s name—it should be Ahimelech (1 Samuel 21:1). Abiathar was Ahimelech’s son (1 Samuel 22:20) who became David’s priest and served David prior to and after his ascension to the throne. It is generally recognized that Matthew and Luke used Mark as one of their key sources. Both tell this story (Matthew 12:1-8; Luke 6:1-5), but neither mentions Abiathar’s name, presumably because they know that Ahimelech is correct.
Jesus is referring to an incident from 1 Samuel 21:1-6 where David, warned by Jonathan, fled for his life from King Saul. While on the run David asked the priest Ahimelech for bread. Ahimelech protested that the only available bread was the holy bread, the Bread of the Presence, also known as the Showbread—bread intended to be eaten only by the priests in a holy place (Leviticus 24:5-9). However, Ahimelech offered to give the holy bread to David if David’s young men had kept themselves from women. David promised that this was the case, and Ahimelech gave him the bread. God did not condemn this action, a fact that Jesus uses to support his contention, “The sabbath was made for man, and not man for the sabbath:” (v. 27).
While Jesus cannot claim that his disciples’ circumstances are as desperate as David’s, the obvious parallel is that both David and Jesus’ disciples engaged in a forbidden activity (David date holy bread and Jesus’ disciples plucked grain on the sabbath) to satisfy their hunger. If it was appropriate for David to eat the holy bread to satisfy his hunger (and the Pharisees would not dare suggest otherwise), then it must also be appropriate for Jesus’ disciples to pluck and eat grain on the sabbath.
But there is also something more happening here. Jesus is drawing a parallel between David prior to David’s enthronement and Jesus prior to his enthronement. This incident points to Jesus’ kingship and his yet-to-come enthronement.
“The sabbath was made for man, and not man for the sabbath:” Jesus puts forth the principle that God gave the sabbath to help people—not to arbitrarily restrict their activities. By abstaining from work on the sabbath, people keep it holy (a service to God), but also gain a day of rest (a service to themselves and their families). In the two instances mentioned in this Gospel lesson, neither Jesus’ disciples attempting to quench their hunger, nor the man with the withered hand have needs that could not wait for resolution, until after the sabbath is ended.
“Therefore the Son of man is Lord also of the sabbath” Son of Man is Jesus’ favorite self-designation. It has its roots in Daniel 7:13. Son of Man comes without well-defined meaning, which suits Jesus’ purposes. The Romans would kill Jesus if he called himself king, and the Jews would convict him of blasphemy if he called himself Son of God.
Jesus has taught in the synagogue “as one having authority, and not as the scribes” (1:21). He has used the title “Son of Man” for himself and claimed authority to forgive sins (2:10)—an authority validated by the healing of the paralytic (2:11-12). Now he pronounces himself “Lord also of the sabbath” (2:28)—putting himself on a par with God (Edwards, 97)
At the synagogue, Jesus commands the man with the withered hand (3:1) to stand up in the center of the gathering, he wanted everyone to see this man and the point he was going to make. He addresses the Scribes and Pharisees, these so called religious leaders of that time and place: “Is it lawful to do good on the sabbath days, or to do evil? to save life, or to kill?”
Jesus’ opponents, of course, would advocate a third alternative: Let’s wait until the sabbath is ended. Let’s honor God on the sabbath and heal this man on the next day. There is no urgency. This man has lived with this condition for years. Another few hours won’t make any difference.
But Jesus has come to bring life and release and freedom. What better time to do a good deed than on the sabbath! What better place than the synagogue! Jesus is obviously at odds with any interpretation of the Torah that would stifle the impulse to relieve suffering on the sabbath.
In our example previously cited, if your house was on fire on the Sabbath day, should the firemen wait until sundown, before attempting to extinguish the flames?
Jesus is saying that he, The Son of God, is Lord of the Sabbath, not the narrow interpretations of his Fathers commandments as enshrined by mankind. What he says, should take precedence of their obsessive adherence to the law.
Jesus sent the message to us that even on the Lord’s day, we should attempt to do good works, to labor, in his name.
What better day of the week, to labor in his name thereby fulfilling his mission?
Benediction:
Almighty and gracious Father, we give you thanks for the fruits of the earth in their season and for the labors of those who harvest them. Make us, we pray, faithful stewards of your great bounty, for the provision of our necessities and the relief of all who are in need, to the glory of your Name; through Jesus Christ our Lord, who lives and reigns with you and the Holy Spirit, one God, now and for ever.
Amen.

Hello Reddit, I'm not really sure if I'm here to seek validation or advice, or maybe just a place to vent. I just feel like I'm being selfish and too demanding on my partner.. Also I would like to apologize for any run on sentences, my mind has been in a haze for the past week with this concern..
I (F26) have been with my boyfriend (M27) for 4 years this August. It was a relationship that started during the covid lockdown. Perhaps at that time, I was just looking for someone to talk to but it evolved into something deeper. I was happy and I felt like I had found someone who really understood and accepted me for who I was no matter how broken and flawed I was.
But I was straight with my expectations for this friendship turned relationship. I knew that I was careless with money but I was willing to go 50-50 on dates or even just having simple coffee dates which was really my thing. I don't really care for the extravagant out of town overnight dates but if it was thoroughly planned as a surprise, I would just as grateful and happy.
He too was straight with me, he was looking for a long term relationship and someone to be honest and straight with him, no beating around the bush or no bullshit kind of guy. Honestly, I needed someone like that in my life too. Sorry I'm rambling.
I am confident to say that I grew in this relationship. Before this one, I came from a 2 year relationship that ended with my partner cheating on me so I found it hard to trust someone else in that regard hence, I wasn't really looking for one (a relationship that is).
But after getting in this one, I learned how to compromise for spending time with each other because at that time, he was working a night shift job and I had a typical 9-5. Weekends was really our only time to spend time and since this started during lockdown, the good majority of us getting to know each other and being in a relationship was spent online.
I also learned to compromise with distance, since he is 2 cities away, in my country that is a good 2-3 hour commute to my place from his so I offered to meet him halfway.
Another thing I learned from this relationship is how to get along with someone of different views or preferences. Nothing too drastic that would cause serious fights, and thankfully we were morally aligned so nothing to worry about right?
But he seems to have taken the sentiment "cutting off all toxic people from your life" a little bit too extreme. It's gotten to the point that it was just me and his mom that he kept in his life. At first I thought that was romantic, like wow I'm literally his whole world. Me being an introvert that doesn't really like to go out to meet new people, I thought it was something really cute. But that didn't mean I didn't have any friends or family... He would get really jealous that I was more willing to plan spontaneous game nights or long night talks with my friends or cousins than with him despite his night shift schedule?? At first it was him being jealous and voicing out that he wanted to talk to me more but as the months went by of him calling me out for it, it ultimately led to him finally telling me that I'm all he has and so it hurts him that I'd rather spend my time with other people.
And I am no saint as well, sometimes I would cut my calls with him short because one of my girlfriends needed me or my cousin wanted to gossip and I knew he didn't like that... So I would try to make it up to him by planning dates or fun things to do while trying to stay sane in the lockdown. (In my country, we had extended lockdown which was longer than the rest of the world's for no good reason).
But we made it work. We communicated, voiced out our concerns and preferences and adapted to it. And I envisioned the rest of the issues we'd face down the line would be resolved the same way.
Now on to my current predicament. He makes me feel like I'm not doing enough in the relationship. That I don't put in as much effort as he does. We have always agreed to split the bill evenly in every date but recently, I have been paying the full cost of it because he's broke. He is broke because March of this year, he experienced heart attack symptoms which got him rushed to the ER. Fortunately (?), it was found that he wasn't experiencing a heart attack but just his heart working too hard... He was diagnosed with hypertension and all his savings went to hospital bills and medicine but when he was short, guess who had to come to the rescue... And I did that because I love him even if he is earning more than me, I wanted to help him as much as I can but I wasn't expecting to be drained both financially and emotionally. Because even after all that, he still demands that I drop everything I'm doing to call him and listen to his woes about being sick.
Now before anyone comments that I'm the bad guy for complaining about him getting sick. One of the things we agreed on when we got together is that he'd stop smoking, not because I don't like guys who smoke but because we both knew that it was a vice that could kill him one day. Hell his closest cousin whom he didn't cut off from his life, died from tuberculosis. So I would've thought that losing him was a big wake up call for him to quit. And he was able to stay sober for 3 years until a few months ago, before he got diagnosed with hypertension. He went back to smoking 2 packs a day as a stress reliever and never told me anything about it until I had to rush to the hospital when his doctor told his mom that he might have a possible blockage in his valve and might need surgery for it.. She of course called me and told me about it. Only then did he admit to me, his mother and hia doctor that he's been smoking 2 packs a day in the months leading up to his heart issue.
Well that was all the context that explains why I've been on edge till now. Because hardships really do bring out the worst in people. All his flaws that I've accepted as a part of him that I saw earlier in the relationship, just got enhanced with panic and paranoia that he got when he was diagnosed with hypertension. So much so that we almost broke up 4 times in a span of 3 months... All because of what he said were my shortcomings:

I was not being understanding enough about his condition. That paying for his hospital bill, meds and heart tests were nothing compared to the pain he's been feeling everyday and I should spend more of my time helping him feel like he's not alone in this suffering.
That even if I had notified him ahead of time that I wanted time for myself for at least half a day, I should still be able to answer his call if he had a panic attack (this reason I would normally agree with had he only called when he was panicking and not every hour good god).
That if I had planned to go out for dinner with my friends that I should get home as early as I can so I could make up for the time I missed because I was out spending time with others and not him...
and that he wanted to see me more often cause he felt like he was dying but that meant me going to his house once a week during his off days but because I just changed jobs and my schedule was now night shift, I had work on his off days. He expected that I had enough energy to go visit him, spend a couple of hours with him, go back home to work (cause it's a WFH job) and still stay on the phone with him as I worked...

And honestly all this just made me feel like what I was doing for him wasn't enough. That I was too immature or selfish for even wanting time for myself because he's the one who's sick and feels like he's dying... And maybe because of the stress that all the money I had saved so I could move out went to him and that I couldn't catch a break from spending time with him (I love him but I need me time too?!?) all just bubbled and erupted inside me and I ended up just saying I was tired and I felt like I was never going to be enough for him...
His response? "If you can't help me, maybe I'll just die then..."
Damn. If I wasn't so mentally, physically, emotionally tired, I would've totally seen this as manipulation to the extreme... But all the years spent molding me into instinctively giving him majority of my time and attention, and most importantly, I do love him. I folded and I rescinded everything I said.
Fast forward to now, he's more stable now and has adapted to a healthier lifestyle. He's overall happier now and finally he was able to apologize for the torment he put me through when he was sick. But the apology didn't feel sincere... It still somehow made me feel that he said sorry I exploded but I had to understand him BECAUSE HE WAS THE ONE WHO GOT SICK NOT ME.
I'm really sorry for the long context. But I think my mind and my heart is tired and I want to let go... But how do I do that? I know it's going to be painful, but does it get better? What is the difference between being selfish and taking care of yourself?

I've observed that CEOs in various companies seem to operate with an INTENSE level of motivation, and what seems to be as if driven by excessively high dopamine levels compared to the rest of the population (perhaps stimulants are more involved than I think but I’m sure that’s not always the case). They exhibit an extreme sense of purpose, knowing exactly what they want and why they want it. Their desire for their goals is AS STRONG as the need for basic physiological needs.
These leaders are not just disciplined; they seem to be fueled by a powerful sense of motivation, as in not that they rely of solely on discipline, but are genuinely motivated. When I listen to CEOs on podcasts, they convey an insatiable drive for success. Their goals are hyper-specific, and they have an unwavering commitment to achieving them.
Failure to meet their objectives isn't an option for them. They approach their goals with the same urgency as needing food or water and extreme, a non-negotiable. I understand there HAS to be a deep sense of mission. A stress to end all stresses.
I’ve noticed that not just CEOs, but even these regional managers maintain an uplifted, enthusiastic, and attentive demeanor during morning video meetings, despite frequent travel and the need for constant organization. They don’t “seem” to slow down or burn out. Their leadership qualities are evident in the way they carry themselves.
I see you guys do it and it drives me crazy. What makes you tick? I want to dial in everything (from my routine and beyond) to win.
I'm trying to understand how to cultivate that same level of drive and determination.
Questions I have:

Daily Routine: What does your daily routine look like, and how does it contribute to your high level of motivation and productivity?
Goal Setting: How do you set and prioritize your goals to ensure they are specific and achievable (i.e type 1 and type 2 decisions, etc)?
Maintaining Focus: What techniques do you use to maintain focus and prevent distractions from derailing your objectives
Dealing with Failure: How do you handle setbacks or failures, and what strategies do you use to stay motivated during challenging times?
Intrinsic Motivation: Can you share any methods or habits you practice to cultivate intrinsic motivation and a strong sense of purpose?
Team Alignment: How do you ensure your team is aligned with your vision and remains motivated towards achieving company goals?
Sustaining Drive: What practices or routines do you follow to sustain your drive and determination over the long term?
Work-Life Balance: How do you balance your intense drive for professional success with personal well-being and family life?
Inspirational Sources: Are there any books, mentors, or experiences that have significantly influenced your approach to leadership and goal-setting?
Advice for Aspiring Leaders: What advice would you give to someone aspiring to develop the same level of determination and urgency in their career?
Given your intense drive and demanding schedule, how do you manage to avoid burnout and maintain your energy and enthusiasm over the long term?

Your responses are invaluable to me, I appreciate any, and all feedback.

Economic Growth (Tax Burden) Motion

This House acknowledges that:
(1) Whilst there are a large number of factors that contribute towards growth, taxes nonetheless play a crucial role in economic recovery.
(2) A balancing act relationship in which —

(a) Tax reduces the incentive to invest in skills and technology, both by individuals and corporate entities, which in turn reduces productivity and then growth; however
(b) Public expenditure, can enhance growth, via items such as defence, justice, education, public health and infrastructure.

(3) There is an observed optimal tax burden for economic growth, clustering between 20% and 30% of GDP.
(4) The current United Kingdom tax burden is estimated to far exceed this optimal window of percentage of GDP —

(a) Utilising the figures of the February 2024 Budget for the FY23/24, the tax burden, calculated out of a total revenue of £1.3 billion and a GDP of £2.4 billion, the tax burden resulted in 55.8%
(b) The OECD average tax burden as per the provisional 2022 data, reported a figure of 34%, with the United Kingom having the highest tax burden of any OECD country, surpassing France’s 46.1%, a near 10% difference.

(5) Evidence on the optimal structure is mixed but usually suggests the following —

(a) recurrent taxes on immovable property, especially land, are least damaging;
(b) transactions and business profits taxes are most damaging; and
(c) estimates usually find taxes on income to be more damaging than taxes on expenditure.

(6) There is an observable negative relationship between high tax burden and economic growth.
This House recognizes the following extracts, summarizing findings supporting its acknowledgment:
(1) Piroli & Pesschner, The Impact of Taxation Structure on Growth: Empirical Evidence from EU27 Member States, 2023:

(a) “Increasing the overall tax burden has a negative impact on growth in the long-run”

(2) Alesina et al, The output effect of fiscal consolidation plans, 2015:

(a) “Fiscal Adjustments based upon spending cuts are much less costly, in terms of output losses, than tax-based ones and have especially low output costs when they consist of permanent rather than stop-and-go changes in taxes and spending.”

(3) Afonso & Jalles, Economic Performance and Government Size, 2011:

(a) “Our results show a significant negative effect of the size of government on growth.”

(4) Johansson et al, Tax and economic growth, 2008:

(a) “a shift of 1% of tax revenues from income taxes to consumption and property taxes would increase GDP per capita by between a quarter of a percentage point and one percentage point in the long run”

(5) OECD, Sources of Economic Growth in OECD Countries, 2003:

(a) “government expenditure and the required taxes may reach such levels where the negative effects on efficiency start dominating, reflecting an extension of government activities into areas that might be more efficiently carried out in the private sector”
(b) “additional negative effect is found for tax structures with a heavyweight on direct taxes.”

(6) Liebfritz et al, Taxation and Economic Performance, 1997:

(a) “a cut in the tax-to-GDP ratio by 10 percentage points of GDP (accompanied by a deficit-neutral cut in transfers) may increase annual growth by ½ to 1 percentage points (a somewhat larger effect than that found by the “top-down” approach).”

(7) Facchini & Melki, Efficient government size: France in the 20th century, 2013:

(a) “the effect of a 1% point increase in the change in the share of public spending is a decrease of the GDP growth rate of 0.19% for the total period”
(b) “66.6% of the studies find a negative effect of Government size, while only 8.3% find the opposite effect, and 25.1% are inconclusive.”

(8) Bassanini & Scarpetta, The Driving Forces of Economic Growth: Panel Data Evidence for the OECD Countries, 2001:

(a) “The overall tax burden is found to have a negative impact on output per capita. Furthermore controlling for the overall tax burden, there is an additional negative effect coming from an extensive reliance on direct taxes.”
(b) “An increase of about one percentage point in the tax pressure - e.g. two-thirds of what was observed over the past decade in the OECD sample - could be associated with a direct reduction of about 0.3% in output per capita. If the investment effect is taken into account, the overall reduction would be about 0.6% to 0.7%.”
(c) “A reduction in taxes and expenditure as a share of GDP somewhat boosted output per capita growth in the 1990s.”

(9) Lee & Gordon, Tax Structure and economic growth, 2005:

(a) “a cut in the corporation tax rate by 10 percentage points will raise the annual growth rate by one or two percentage points.”
(b) “the corporate tax rate is significantly negatively correlated with economic growth in a cross-section data set of 70 countries during 1970-1997.”

Therefore, this House urges:
(1) The Government takes the necessary measures to ensure that the national tax burden is kept at no more than 30% of GDP in adhering to empirical findings for economic growth.
(2) The Government to reduce the United Kingdom’s fiscal reliance on direct taxes in the long-run.
This Motion was submitted by u/Kellogg-Briand on behalf of the Centre Party with contributions from the Right Honourable Dame u/Waffel-lol LT CMG GCMG, Leader of His Majesty’s Official Opposition and is sponsored by the 39th Official Opposition.
Sources and References
OECD, Revenue Statistics 2023
The Budget (February 2024)
OECD, Sources of Economic Growth in OECD Countries, 2003
Liebfritz et al, Taxation and Economic Performance, 1997
Facchini & Melki, Efficient government size: France in the 20th century, 2013
Bassanini & Scarpetta, The Driving Forces of Economic Growth: Panel Data Evidence for the OECD Countries, 2001
Lee & Gordon, Tax Structure and economic growth, 2005
Taxes, growth and the tax burden
Opening Speech:
Mr Speaker,
This is a matter of crucial importance and the New Liberals and Centre Party, alongside the Liberal Democrats have worked to bring forward a key concern that we have regarding our nation's finances. The United Kingdom has the highest tax burden amongst the OECD countries at nearly 56%. Not only exceeding the OECD average of 34% but this is a figure that is nearly 10% above the runner up of France at 46.1%. This level of tax burden is very dangerous and harmful for the aims of economic growth. In supporting our assurance of this matter, this is a position that has been backed up and supported by decades of academic study and research where there has been clear evidence and a negative relationship between the tax burden and economic growth. The current tax burden we have is comparatively ridiculously high and we urge the urgency of measures to reduce this tax burden and unlock growth for our economy.
This division closes at 10PM BST on Tuesday 4 June 2024.

So I really need to get into an endocrinologist. I was told I have a hormone disorder when I was a kid, but wasn't given a proper diagnosis or testing, & was just thrown on Kariva at 12.
This pill caused so many problems, & I wasn't even aware that they were from this pill until I quit it after my bisalp at the end of 2022 (9-10 years after starting Kariva). It was the cause of my gender dysphoria (mostly went away after quitting the pill), it gave me suicidal ideation EVERY month before+during my period (also made my periods more regular, bad thing in this case) it landed me in the hospital many times due to that, it gave me mood swings so bad to the point I regularly ruined my relationships with family & friends alike, & so bad I was falsely diagnosed as bipolar (which made it so they wouldn't diagnose the issues I actually have, autism & adhd. They didn't get diagnosis until I was able to quit Kariva.)
All of the things it caused, resulted in significant trauma over the course of my life. I feel safe saying that Kariva, ruined any shot that I had at life.
The only good thing I have to say about it, is that it made it so I rarely got acne. I have had acne from hell since quitting the pill, which sucks & I'd like it to get treated, but absolutely not using estrogen as a part of it at all.
I know that PCOS (what I suspect it is) can cause all sorts of stuff, some of which I have- Like high blood pressure, obesity, & high cholesterol. I just started a beta blocker because I was in severe hypertension & it got worse upon standing (diagnosed with dysautonomia) and I've been eating heart healthy for a while now. The beta blocker is really helping the hypertension & my heart rate, but nothing's helping my obesity & high cholesterol. I'm only able to keep weight & levels from shooting up more, I cannot lower them.
I'm happy with the masculinizing effects it gives me. I like my facial hair, I like having a "boyish face", I like my deeper voice, I like being a little more muscular. As I mentioned, taking combination birth control gave me dysphoria, I'm not necessarily dysphoric anymore now that I quit it, other than lacking bottom growth (which I only think is because I was put on the combination pill a year or two after starting my periods, & being on it for 10 years. I'm pretty sure I would have had some growth if not for that. I'd like to start topical eventually to reach what I feel is right, but that leads me to my question...)
I'd like to find treatment, but I'm very scared that I'm gonna go to a doctor and their immediate answer is gonna be "take birth control" again. I'm limited as to how far I can go, because I'm disabled and rely on my grandparents for transportation due to being unable to afford a car & there being no public transit available, but they're only willing to drive at most 30 minutes to take me to doctors. I live in Wixom, Michigan. When I look on the sites specifically created to find trans-friendly doctors, I see ABSOLUTELY NO trans-friendly endocrinologists within this range, they're all a further drive than I'm able to get to. If I go to a doctor NOT on this list, and they have no answers other than birth control, I'm not going to be able to find another one, because my grandparents are the ones in charge of getting me places, and they're gonna get mad that they have to drive me all over to find one, and also get mad that they have to pay all of these doctors bills for me when the doctor didn't even help me. I'm trying not to make them mad, because they're the only ones who will help me, so if I screw it up with them, my life is literally over.
HOW DO I FIND A DOCTOR THAT WILL HELP ME IN THE WAY THAT'S BEST FOR ME? I'm scared they're gonna brush away my concerns and try to put me on estrogen, because I have historically been ignored/brushed off by doctors (like taking 15 years of doctor shopping to diagnose my dysautonomia) and I have like, ONE shot at finding a good doctor before I have to worry about angering my grandparents.
Anyone know a good endo that's like, 15-30 minutes from Wixom, Michigan, who just hasn't put themselves on those lists yet? Like, someone in Novi, or South Lyon, maybe? I want to get treatment but I'm gonna flip out if I get a bunch of testing done & they just say "take birth control" again. 😭

(Cong Rats u/Xerxes250! You've been FICNAPPED, EKEKEKEK! Thanks to u/Espazilious, u/CaptainMatthew1, and u/T00Dense for supporting me in Group 3 of the Ficnapping!
That's right, I've Ficnapped Hazardous Recovery, a very well-written fic. I'd recommend it to those looking for a more... tech-inspired fic.
So, enjoy the dumb stuff.)
-====================================-
Memory Transcription Subject: Kimmich, currently dying inside
Date [standardized human time]: October 25, 2136
If I had been made aware that one of the first days we were on Earth was going to be spent sitting in a predator's house, looking at sheets of paper, and listening to said predator prattle on about silly plastic shapes with numbers on them I'd have refused the trip as a whole. The whole concept seemed like a massive waste of time, not only for us but for him too. Unfortunately, I was trapped here by the whims of Vemnka and Sevkan, and they never let up a chance to see new human past times.
Andre, for his part, had been slow with us, letting us ease into the new living situation with relative laxity on where we were allowed to go. We'd already watched a few movies, played a few "video games", and even listened to some of his music. It was... enjoyable. Even with the obvious attempts to cover up a whole heap of predatory behaviors, Andre had managed to get us feeling somewhat welcome.
Until he had us sit at his kitchen table and write out the Venlilian numerical system, to which he responded with a chuckle, "Looks like Skaven Scratch." He did not elaborate. At first, I thought the exercise was going to be a simple lesson on how to read human numbers. But no, it was far worse. Instead, Andre went to his workshop, scanned all the numbers, and began printing a bunch of geometric prisms with the numbers on them. Vemnka was the first to ask about their purpose as she picked up a dodecahedron, each side holding a numeral.
"Well, I figured we'd play a game, and these," he held up a worn version of the same shape Vemnka was holding, this one with human numbers on it, "are how we play."
Not even a minute later we were watching as he 'rolled' the 'dice' across a little pad on the table. "So, basically, these dice, the 'd6's will help us make our characters. I use the '4d6 minus the lowest rolled' method for stats, but there are other ways to do it."
Sevkan picked up a triangular prism and poked his paw pad with it. "And what about the rest of them," he asked as he tossed the plastic shape onto the pad.
"The one you just rolled is a 'd4', it's a damage dice. Same with the d6, 'd8', 'd10', and 'd12'. This," he held up a dice with ten sides, but with two separate numbers on each face, "is a percentile dice. Helps when I need to see what outcome happens when a random encounter starts, though we'll not be using it because we're doing a oneshot." He flicked it up with a click and caught it. Next, he picked up the same dodecahedron as before and rolled it. "Ouph, nat 1, less than ideal when starting a game."
"What does that mean," I asked, looking down at the twenty-sided dice; the side displaying '1' was facing up.
"A nat 1 is the worst roll on a 'd20'. It's a critical failure, which means if you roll a nat 1, something bad happens." He rolled it again as he talked, "The d20 is the most used dice because it's the 'check dice', you use it to figure out how well you did on an action. For instance," he reached across the table for a sheet of paper. Looking it over, I could see it was a 'character sheet', as Andre called them. "This is the strength stat," He pointed at a block on the left side of the paper, "It shows how strong your character is. If I were to roll this d20 and get a 13, but your strength stat is a 14, plus whatever save modifier you have, then I'd fail the check and either nothing would happen, or you'd get a reaction to my failure." He shifted his weight as he reached for the ground. With a plap, Andre brought up a hardbacked book. My translator had a bit of difficulty translating the text due to the font, but in the end, it spat out 'D&D Player's Handbook'. A small script of subtext under the cover art, which I ignored due to its content, read 'Everything a player needs to create heroic characters for the world's greatest roleplaying game.'
"A roleplaying game," Vamnka asked before Sevkan or I could formulate the words.
"Yep! A TTRPG, Dungeons and Dragons, D&D. I played this once or twice before my accident with the reactor room, but I think I still remember enough to DM for it."
This time Sevkan asked the question, "TTRPG and DM?"
"Tabletop roleplaying game, and Dungeon Master. I run the game, so I'm the dungeon master." He laid out three sets of three pieces of paper at each seat. It had the same words and markings as the one before him. "So, as I said, we're doing a one-shot because I can't be bothered with doing a whole ass campaign. Plus you won't be here forever and we have work to do at some point."
"I'll be making your characters with input from each of you. We're doing basic fifth edition rules because the newer editions, sixth up to ninth, all suck." He grabbed four of the d6 and held them aloft, looking at Sevkan, then Vemnka, and finally landing his gaze on me. I felt my fur rise but paid it no mind as he looked down at the dice before him. "Vemnka, you're going first." He picked up and tossed the dice to Vemnka who scrambled to grab all four before they had a chance to fall off the table.
"So, I just... toss them?" The quizzical flap of her left ear was met by a curt nod from Andre. "Alright," she said as her paw flicked the dice across the table. One landed on 1, another on 2, another on 3, and the final one on 6. "Twelve in total," she announced.
"Good, now remove the lowest number rolled and mark it down somewhere on the back of your sheet."
After five more rolls, Vemnka's stats totaled 11 in strength, 15 in intelligence, another 15 in constitution, 16 in wisdom, 16 in charisma, and 13 in dexterity.
Next was my turn. I rolled a 13, which I put into dexterity, a 14 in constitution, a 15 in charisma, a 16 in strength, another 16 in wisdom, and a 12 in intelligence.
Finally, Sevkan rolled a 12, which was placed in dexterity, a 13 in charisma, a 16 in constitution, a 10 in both wisdom and intelligence and, as Andre put it, the ever elusive 18 was put in strength.
With all that tedious, boring, unimportant, and downright torturous work out of the way, now was the time to get into character creation. Andre gave us the book to look over and told us to ask any questions we wanted if we needed to. I pulled up my pad's visual translator and began skimming the text.
-====================================-
Memory Transcription Subject: Vemnka, having the time of her life!
The book wasn't big, not by a long shot. I'd read books three to four times as long in [a day] or two. What the book contained, however, was an entirely different story. It wasn't just a rulebook, or handbook, as the cover suggested, it was a way to shape the wild imagination, to tame the itch to create.
And by the stars am I creating!
Andre told us we'd start by choosing class, race, and background. Of course, we had no idea what that meant, so he took us through it one at a time at a leisurely pace. He flipped through the book's pages before landing near the beginning, showcasing a stout-looking human with the undertext 'Dwarf' printed to the left.
After running through all of the vaguely human-like races to pick and a few classes that would shape our table-side adventure, I'd chosen to be a gnome cleric, which was a humorous choice. Andre said I'd primarily be healing, helping my team by keeping them in battle. I didn't mind the idea of being a sideliner, as long as I could help.
Dad had chosen to be a human 'paladin'. Andre explained that the term equated pretty easily to a form of holy guardian, in the form of a mortal, who the god of their faith gifted to defend those around them. Dad thought is was a pretty cool idea, especially the idea of "burning heretics away with holy fire," as Andre put it. It took him a bit longer to choose his race because he kept returning to the page with the almost-Arxur-looking Dragonborn. Still, after some coaxing, he finally let up on whatever was going on in his head and chose the easiest option, and the one Andre had recommended.
Finally, Sevkan had looked a bit farther into the game itself, finding a non-classified databook called "Player's Companion". Andre described it as a supplemental read, adding a bit more variety to the already large amount of options presented in the Player's Handbook. Sevkan took one look at it and immediately chose the Aarakocra, causing Andre to flinch. He said it'd be fine because the Aarakocra looked nothing like Krakotl, but Sevkan still apologized as best he could. He chose the fighter class, which was about as self-explanatory as possible.
Next was backgrounds, I chose to be an acolyte. It made sense in my head that a religious healer would have a background in religion. Dad leaned toward Folk Hero as his background, an option that both he and Andrew agreed would suit his character. Sev chose to be a hermit, which caught me and dad off guard after Andre gave us a rough rundown of what it was. An isolationist fighter, the sort of stuff that got you locked away.
"Alright," Andre said, leaning forward, looking between each of us again. I noticed Dad's fur rise a bit less than last time. Progress is progress. "We've got a Gnome Cleric, a Human Paladin, and an Aarakocra Fighter. Pretty good party dynamics for your first time even hearing about DnD. Now, for the most part, we've done everything we need to do together. From here you would have normally gone through stats and equipment, but I don't want to, and this is a oneshot so those aren't that important. Vem, on that last sheet, please mark down 'Spare the Dying', 'Sacred Flame', and 'Guidance'. Kimmich, on your last sheet, mark down 'Lay on Hands', 'Divine Smite', and 'Divine Sense'. Sev... you can just throw that sheet away. You won't be moving past where you are now."
Sevkan looked down at the sheet with a hint of sadness. To be fair to him, 'Spare the Dying' and 'Divine Smite' sounded cool, but before I could ask what they meant, Dad beat me to it. "What are these for? What do you mean?"
Andre rolled a D20 absent-mindedly, "Spare the Dying is a Cleric Cantrip that stabilizes a person who's taken fatal damage and is rolling death saves. Divine Smite is that whole 'BURN IN HOLY FIRE' thing I was talking about. Depending on how you flavor it, it's you wrapping your weapon in divine fire and burning away at your enemy's soul."
Despite his previous misgivings, ones which were practically plastered over his fur, Dad seemed honestly interested in the concept behind the Divine Smite. "And I just get to use it? Any time I want?"
"Well, not really." Andre pointed a finger toward me. "She has three cantrips which can be used at any time, you only have two. Divine Smite is an actual spell, as in its magic that requires you to utilize a spell slot. Lay on Hands is a contrip that can heal and Divine Sense allows you to detect certain types of creatures based on their alignment. Good and Evil in particular."
Sev spoke up, displaying confusion with his ears. "So why don't I get any spells or cantrips?" There was a degree of disappointment in his voice.
Andre leaned back with a chuckle, flexing his dexterous prosthetics as he clutched the d20 he'd been rolling. "Because, as a fighter, you probably have the most useful ability of them all. It's called 'Second Wind' and its essentially Lay on Hands but only you gain from it. It's an ability you can only use once per short rest, which we won't be needing to get into, which heals you for 1d10 plus your level, which all of you will be set at level 2.
"Again, we won't need much of the stuff in the books because this is A. Your first time and I want it to be fun, and B. A oneshot where nothing matters and we're here to have a good time. So, real quick," Andre grabbed a d8s and a d10 and began rolling them. "Vem," the d8 clacked across the table, landing on a 4, "you've got 15 health total. Because you're a light class, always expect to be on the lower side of health. Kimmich, you've got," he rolled the d10, it landed on an 8, "20 health, not a bad roll. And finally Sevkan," the d10 rolled across the table once more, the 5 side facing up. "18 health. Not too bad either, given your ability to heal yourself."
"How did you get those numbers," I asked, looking across the table at each of our sheets.
"While you all were reading, I put your modifiers where they belong, and changed what needed to be changed with your stats." Andre leaned over and pointed at Dad's sheet, "I increased each of your scores by one because you're human." He moved to mine, "I increased your intelligence by two." Then he moved to Sevkan's "And I increased your dexterity by 2 and wisdom by one. I made a slight mistake when asking you guys to roll, as usually, you'd choose race and class before putting your stat rolls anywhere, but you all seem to have put them in pretty good spots."
The three of us gave Andre amused looks, to which he raised an eyebrow. "Humans get an additional point in everything?" Sev asked with a small whistling laugh.
"Oh, uh. Yeah, now that there are actual other intelligent races in the galaxy that doesn't look too good does it?"
"It's fine," I said. It was plenty understandable, thinking you're the best at everything you do when there's no one to compare to. "So are we going to start?"
"Yep! Just one more thing. Weapons and armor are important to this, even if you don't have to use them all the time." Andre flipped to a page with a list of item names which I couldn't make ears or tails of. I recognized 'sword', 'bow', and 'spear' as ancient primitive weapons, but other than that everything else escaped me.
"I'm noting a lot of confusion. Anything you need to know?" Andre looked at us expectantly.
"What's a 'maul'," came Sevkan's response.
"Oh, that's a term for a large, two-handed warhammer. Usually, it's depicted as spiked on both ends. Imagine a very large, very crude sledgehammer with spikey bits."
"And a 'glaive'?" Dad asked next.
"I assume you know what a sword is?" We flicked our ears in affirmation. "Well, it's essentially a curved sword attached to a pole. It's made to look a specific way, if it wasn't then it'd probably just be called a Dao. Or maybe the Dao would be called a glaive. Maybe Glaive is just a type of polearm. I have no idea. Anyway, to speed this up, I'll be choosing the weapons and armor you can have for you, and don't worry, I'll use your attitudes as a reference for what you get. For you, Vemnka, I think the mace and shield combo will do nicely with the scale mail. Kimmich, you'd work well with two long swords to accompany your chainmail armor. And finally, Sevkan, a halberd with your chainmail will work fine. Sound good to everyone?"
I was a little disappointed at the stolen opportunity to continue building my character, I'd yet to come up with a name or backstory, as I was sure was the norm, but with the idea of starting taking center stage, I couldn't help but wag my tail.
-====================================-
Memory Transcription Subject: Sevkan, going down the rabbit hole
Andre put a thin plastic sheet over most of the table, took out a bundle of markers, and began drawing, much to our collective surprise.
The sheet was was smooth and cool to the touch, though not through any internal system, probably just from the back of the garage where Andre had found it. It had a grid printed over it, which Andre seemed to be using as a guide as he drew a boxy shape, marking certain areas with certain colors. There must have been a system he was following, one that none of us Venlil in the room had managed to pick up on, and we didn't want to interrupt Andre as we worked in case we caused him to mess up.
I looked over my character sheet, made mostly by Andre with small additions I felt like I needed to add. I still felt a little bad for not realizing how raw the image of a Krakotl must have been to Andre as I chose the Aarakocra, but he'd brushed it off swiftly and curtly, clearly not wanting to continue the line of thought. Still, I should've chosen a different race. The goliath looked cool and probably would have been a better fighter than a bird with hollow bones, but I also didn't want to drag the others much longer, so I kept silent.
At long last Andre stood at his full height and analyzed his work. "There we go. The battle map is set up, now for the tokens." He reached into his back pocket and pulled out three little white objects. I immediately recognized them as chess pieces. A rook, a knight, and a bishop were placed on the table, along with a dozen white pawns, some of which came from a different chess set, and four black pawns as well as a black king. The black pawns were marked with the colors, yellow, beige, green, and white. We quietly agreed which pieces we would be. Dad would be the knight, I would be the rook, and Vemnka would be the bishop.
Andre sat down and we began. "Alright, I've decided to pull the classic 'wake up in a tavern' DnD start because it's funny and I also didn't exactly plan this. So here we go. Please leave your questions for after I'm done talking."
"You wake up, each of you, around a wooden table in a comfortable tavern with candles above you and empty tankards before you. You look at each other and recognize if only barely, the friends you made last night through a bout of drinking and dancing. You feel the roaring of a hangover in your head as you each groan and attempt to lift your heads."
Andre pointed at the chess pieces, which must have represented our characters. "Please roll constitution to see if the hangover affects you in any major way. It's a d20 plus the number below the stat itself."
We looked at each other with slight confusion. Not at the command to roll, nor for its circumstance, but for the setting. Is this a human board game? I mean, I guess I expected something more akin to chess. but this is nothing like it. It's so... alien.
Dad rolled his d20 first; it landed on a 16, "An 18?"
"Yep, Kimmich, your character brushes off the hangover with ease. You still feel a buzzing in your head, but other than that, you're fit as a fiddle." Oh, I get it now. How interesting. I could see Dad and Vemnka twitch their ears in understanding as I rolled my d20.
It landed on 8. "Plus two, so an 11."
"Sevkan, your head hurts like hell but you're still able to function to a normal degree. If it weren't for your fellow drunkards you're sure you'd have to stumble around by your lonesome for a while."
Vemnka let out a laugh as she rolled her dice. While she had been aiming for the center of the table, the dice had other plans and shot off to the right, flying off the table and rolling under a stool in the kitchen. "Oops! I'll get it," she said, jumping out of her seat and lifting the stool. "It landed on 19," she beeped excitedly.
"Nope," Andre said, much to our surprise. "Rule two of dice: if it goes off the table, its results are null. I didn't make that rule, but I still follow it. Roll again."
Vemnka's ears drooped a bit, but she set herself and climbed back into her seat to roll again. This time the dice did as it was meant to and rolled across the table without falling off. It landed on... "A nat 20!"
"No shit?" Andre lept out of his chair to peer across the table toward the dice. "Well, I'll be damned, a 19 and a 20 in succession. Well, I guess you're just better than those other two. Your character's hangover is completely gone, you felt it for all but a second as you raise your head to see your Aarakocra companion still struggling with his."
"Is there anything I can do to help him?" She asked. Andre's lip curled upward slightly.
"Now you're getting it. It's a role-playing game. You have your roles, the ones you set up for yourself, and now you get to play them. And yes, there is something you can do to help. Roll me a medicine check. I'll add your modifier myself." The sound of a die rattling across the table ended with... "Another Nat 20?!"
We jumped at Andre's incredulous shout as he glared at the die before him. He seemed more angry at the dice than at Vemnka so I assumed we were probably not in trouble. How can we be? We didn't do anything that would make him angry. Why's he yelling?
"Sorry, but the chance of rolling two nat 20s in a row, while not astronomical, is pretty fucking low. Something like a one in four hundred chance, maybe more," Andre said, sitting back down and sighing deeply. "It's fine, just funny is all. Usually, RNJesus is on the DM's side, not the party's. Kinda nice to see a change of pace."
"RNJesus," we asked collectively.
"Don't worry about it, let's continue. Vemnka, you put your hand on Sevkan's shoulder and do some voodoo magic bullshit and pray to your god to heal his aching body. Miraculously, it works and Sevkan sits upright feeling light as a feather. The Aarakocra's headache is now on par with Kimmich's."
"Just like that?"
"Just like that, now let's get on with it. As Sevkan gets up and shakes off the remaining ebbing in his head, you all notice five less-than-reputable figures sitting in a booth at the far end of the tavern. Each wears a hood or cowl accompanied by a cloak, which hides their race and weapons from you, however, you can tell that one of them is considerably larger than the others. If you had to, you'd place it at about 226 cm (7'5") while those around it are around the average human height of 180 cm (6'0"). Roll me perception too."
We looked at each other at the description but shrugged it off as we rolled. I rolled a 7, Dad rolled a 19, and Vemnka rolled a 17.
"Both of you," he said, pointing at Vemnka and Dad with one hand, "See that they are pointing in your direction while the big one holds a piece of paper in his hand. It shows artistic renditions of the three of you, along with a long string of words you can't make out from your current distance. Kimmich, you hear them talking about a bounty and that you are the specified targets. Now it's time for you to react, how do you want to move forward?"
"Well," Vemnka said nervously. I could see her tail flick in my direction, looking for guidance, but I had none. "I suppose I'll confront them? I'm not sure what a bounty is exactly..."
"Really?"
We looked at Andre and the obviousness of the situation. If we didn't know what a word was, we knew it must have been predatory. "Right, sorry. Bounties are orders given to hired people to hunt people. For one reason or another, if someone wants someone dead then they'll place a bounty on their head. I'm not sure if it was ever actually a thing, but bounty hunters were popular during the Wild West days of the US. They usually brought criminals in for trial though, and usually didn't kill them."
"Okay, but why do they want us dead," Dad asked, his ears falling back slightly.
"That's the neat part, you have no idea," Andre said as he leaned forward and moved the green-tipped black pawn a space on the map. "Vemnka, as you get up, you notice that one of the figures is moving towards the door with slight urgency. Before you can make a move, however, the large figure stands up and doffs his cloak, revealing the tattooed grey skin of a Goliath wielding a greatsword in the executioner's style. He shouts over the tavern for everyone other than your group to leave immediately as things are about to get bloody. His three other goons, the one moving toward the door exempt, move in unison towards you. Roll initiative. It's a d20, same as all the others."
I looked toward my sister to see her tail freaking out, her bishop is the closest to the enemy party, meaning she was more likely to be targeted first. I had to protect her, not only because of our sibling relationship but also because she could heal us if we got hurt. The three of us rolled as one, I got a 10, Dad a 14, and Vemnka got a 4. Andre himself rolled a few dice before moving the chess pieces into place and writing down something on a sheet of paper. "Alright, perfect. Initiative rolled, time to start combat. First up, yellow pawn."
He moved the pawn toward Vemnka's bishop, immediately putting her in danger. "One of the vagabonds rushes you, Vemnka, and you see the flash of Tabaxi claws as they raise their hand to strike at you." Andre's dice rolled, clattering to a halt inside the pad on his end, obscuring the results. "Does a 14 hit?"
"How do I check that," she asked, her tail going even crazier. Though, I couldn't tell if it was excitement or panic.
"AC," Andre responded flatly, "Armor Class."
"Right, yep." She looked down at her paper and flicked he ears 'no' then shook her head.
"The Tabaxi's claws swipe right above your head and miss by a hair. You can even feel the air move past you as you flinch backward. Next, the Goliath moves toward you, hefting his greatsword. Kimmich, if looks could kill, you'd be halfway to Valhalla by now. He glares at you with a mighty fire in his eyes. It's hard to tell, but you think he might have it out for you. He takes a swing with his sword and..." Andre rolled and looked back up at the table, his eyes focusing rather intensely on the black king representing the Goliath. "Meh, Nat 1. He swings and you dodge, causing his swing to miss wildly and land on the Tabaxi nearby. She takes," he rolls, "A sizable chunk of damage as blood flows from her lower abdomen."
"Wouldn't she be writhing in pain right now," Dad asked, pointing to the yellow-topped pawn.
"In real life? Yes. Here? I control the game, and while she is certainly hurt, she still has enough will to fight. Money is a powerful incentive for some people, especially bandits and vagabonds. Next, Sevkan, you notice the flash of steel as a dehooded human rushes you with a shortsword in hand. He has a keen eye and sharp nose, but your reflexes are faster as you dodge his swipe. He stumbles a bit, but recovers before you have a chance to harm him." Andre looks at Dad, who doesn't even seem to register the human's gaze as he looks over his sheet. "Kimmich, it's your turn. You can attack, retreat, use a spell-"
"Divine smite the Goliath, I'll use Divine Smite on the Goliath."
Andre lets out a chuckling laugh, "Now we're talkin'. Let's do this. Roll for attack."
Dad rolled, and I watched as the dice skipped across the table and finally landed on 11. "Plus five, so 16."
"Very good, that is a successful hit. Please roll both damage and the Divine Smite's 2d8."
Dad rolled his d8 three separate times, coalescing in a massive 18 damage, a 7, an 8, and a 3. "18 damage total against the Goliath."
Andre did a weird whistle as he marked down the information on what I could only assume was the stat sheet for the enemies. "18 against big guy. Sevkan, your turn. D-"
"Actually," Dad interrupted, "it says here that I have an extra action and a bonus action."
"Oh."
"So I'm going to attack him again."
"Okay."
Dad rolled another d8 which landed 6 side up. "Another six damage and I end my turn."
"Thank you, finally. Sevkan, go, please. Attack or... Well, all you can do is attack." Andre leaned back in his chair, stare planted squarely on me. I looked down at my sheet for any actions I had. I had a normal and bonus action, and that was it. I looked at the section marked features and traits and noticed that I could do three actions with action surge. "Alright, I'll attack three times. Twice with my halberd using action surge and once with that dagger, you forgot to give everyone that we all had the option to take." I glared right back at him.
"Yes, I didn't give you all the tools you could have had because it would have just wasted more time. But fine, if you want to use it, fine. It's a d6 slashing damage."
I rolled the 2d10 for damage. One landed on 8 while the other landed on 9. My d6 lands true on a 4. "21 damage to the beige-tipped pawn. That's the human, right?"
"Yep," Andre nodded as he wrote down the damage. "You take two swipes at the human with your halberd, both connect with both his arms and torso, slowing him considerably. It's only when he remains standing that you pull your dagger from its sheath and plunge it into his chest. You miss his heart by millimeters, but it does the job as he collapses in a pool of blood. Congrats, first knockout of the game."
I shudder at Andre's description of my character, who might as well be interchangeable with a Krakotl, killing a man. A human, for that matter. I look over to see Dad glaring daggers at Andre and Vemnka staring at me worriedly. I wave her off with my tail and focus back on Andre.
"Retribution is in store for you, though, as an Elf leaps over a table with two daggers drawn, ready to avenge her slain comrade. She..." Andre rolls and whoops as he punches a fist into the air. "She comes down with blinding speed and rakes her metal blades across your chest," He rolls again and lets out a slightly disappointed 'oh' before continuing. "You take a total of 8 damage from the Elf's daggers."
Andre, once again, leans forward, this time to remove the beige-tipped pawn from the table and replace it with a red cross, as well as move the green tipped toward where all the white pawns were. I assumed the gap in the markings must have been a door, as Andre had moved all the white pawns out of it when combat started. The green pawn must be escaping or blocking ours. Either way, we have to deal with the three remaining in front of us before we can handle that one.
"I see gears turning, always a good sign, but let's continue. Vemnka your combat turn. Make it count. You can use your bonus action to heal or attack with your mace, it doesn't matter as long as you do a different action when using it."
Vemnka looks over at me, then to the board with a contemplative look. "I'd like to use my first action to bless the two of them, then I'd like to use my bonus action to bonk the -what did you call it?"
"A Tabaxi."
"Yeah, that, I want to bonk that." Her tail swayed with contentment as she rolled her damage dice. It rolled into the batch of white pawns before landing on 6.
"Ouph, 'fraid that's not gonna be enough to hit anyone, but, Kimmich, Sevkan, both of you can now roll a d4 to accompany your attack roll." He flicked his d4 into the air but somehow missed it as it fell. It clattered onto the table and got flung into the living room as Andre tried to grab it. "Fuck, alright, hold on. Damned carpet's gonna be the death of me."
He went looking for the die, leaving us Venlil staring at the table before us.
"So what do you think," I asked abruptly.
"I don't know," Dad responded, his tone careful but gruff. "It's very clearly predatory. I mean, we wake up in a tavern after a night of drinking so hard our heads feel like they're about to explode and once the hangover clears we've got a band of roughnecks out for blood from the get-go." He squinted at the chess pieces representing our characters, they were all next to each other. "And I can't even really argue that we should stop because I'm fine with what's being depicted. Even if his description of you... knocking out that human was a bit over the top, I think that's the point."
"I agree," Vemnka spoke up, "The whole game is very fantastical, not meant to be compared to real life. I mean, sure, the concept of bounty hunters is a real thing, but I don't think there are humans as tall as that Goliath walking around. Or whatever a Tabaxi is."
"Fantastical and weird. If those don't describe humanity, I don't know what does," I said with a bemused flick of my tail.
"How about tired of hearing you talk about me behind my back," Andre's voice shouted from behind the couch, where he was scrounging for the lost die. Finally, he seemed to have found it, poking his head out from the backrest and looking over at us. "I'm joking of course, I don't mind at all. Unless you're insulting my taste in music, then we'll have a problem."
"I-I mean it's just-"
"Not for everyone, yadda yadda yadda. Anyway," Andre stood up, holding the d4 in his hand. "Lets continue. Tabaxi time." He took his seat and leaned forward to adjust the white pawns before rolling the hit dice. "Bruh. Another Nat 1. And here I was imagining the Goliath and Tabaxi to be the leaders of the group. Whatever. The Tabaxi attempts another swipe at you, or so it appears because she ends up cat-scratching the arm of the Goliath next to her. That's five damage, and it moves to the Goliath who is slightly pissed at everyone except for the Elf, who's, y'know, actually put in some work. The Goliath makes a wide swing, hoping to cut you all down in one fell swoop." He rolls the d20 three more times, once with a 'whoop' of success, another with a 'aww' of failure, and a final with a 'oh come the fuck on.' I could only assume it was a horrible failure. Andre's sigh fills the room. "Alright, Kimmich, you take 18 damage, he crit succeeded. Sevkan, you take no damage, and instead duck low as the swipe passes over you. Vemnka, you feel the blade move over you, but it does not connect due to your short stature. No, instead, he once again hits the fucking Tabaxi with his swing because he crit failed. Again. And because the human is no longer available to fight, it's now your turn Kimmich."
"I would like to smite again."
"Oh fuck, right you get two 1st level spell slots." Andre almost sounded annoyed when it was brought up, but relented nonetheless. "Take the hit dice."
Dad rolled, and it landed on 14. He rolled the d4 for the blessing Vemnka gave us. It landed on a 3. "Plus the five-"
"Yeah, yeah, it hits. Roll me damage."
"I'm sensing some hostilities from you," Dad said smugly.
"I'm starting to understand why my DMs hated being DMs, that's all. Please, fuck up that Goliath." And so he did, rolling a 15 in total. "You swing one of your longswords upward and cleave the Goliath's jaw in two, but he does not die. A mere flesh wound such as that would do little to dampen the giant-kin's will. No, what killed him was the bright light that engulfed his head after the strike landed. His face was the first to go as he tried to breathe through the holy flames surrounding him. His screams ended abruptly as his larynx melted away, leaving only writhing agony. He died a pitiable death in all fairness, as any sinner does. The second knockout of the game goes to Kimmich. Yay."
Again, the feeling of discomfort appeared as Andre described in unnecessary detail the visual of... someone burning alive. Oh stars, he planned that out, didn't he?
"Let's move on. Sev, your turn. First, lemme see you all roll perception again."
I rolled a 10 while both Dad and Vemnka rolled 16s. Adding modifiers made their 16s into 19s. "Alright. Again, Vemnka and Kimmich only, you see the figure who'd been moving toward the door at the beginning of the fight, now make a break for it as the Goliath collapses into a burnt-out husk. His hood is removed by the movement revealing it to be a green-scaled Dragonborn." Andre moves the Dragonborn's piece next to the door and through it, stopping it just within our sightlines. "He has a chance to escape, will you let him?" He looked at us expectantly.
I turned to Dad to see him eyeing the piece like a fresh firefruit. "Dad, no. If he leaves then that leaves the Elf and the Tub- Taba- Tabasi, whatever it's called. We can end this soon." Vemnka put her tail on his shoulder in an attempt to get his attention. He flinches at the touch and lowers his raised fur.
"Yes, yeah. Let him go," he says hoarsely.
"Alright, letting the Dragonborn go. Now it's Sev's turn. Go ahead and do something about his pesky elf." Andre moves the Elf's pawn a bit to put it back on the right square.
I shrug, attempting to fight off the conflicting feelings. On one paw, it's a game and no one is going to get hurt by me doing these things. But on the other, if I do this willingly does that make me any better than someone who would kill in real life?
Andre's voice snapped me out of my stupor. "Don't overthink it. It's a game, and this situation is self-defence. Kimmich is the only person here who's killed someone so far. The human will probably live in prison and the Dragonborn might find new meaning in life. It's not like any of this properly reflects the real world anyway. Just focus on the game, nothing more, nothing less."
I shook my body to rid myself of those thoughts and rolled my d20 and d4 from the blessing. "18 to hit."
"And hit it does. Halberd is a go!"
With another roll, it lands on a zero. "Got a 0?"
"Oh, yeah, the model I imposed the numbers on only uses one character for each side, but that's a 10. Good roll. Elf takes 10 damage and doesn't like you right now. I'm super tired of talking, so I'll just roll the hit dice. She attacks you for 19. Your AC is 19. Meets it beats it, that's a hit. Rolling damage, she lands a solid blow of 9 damage for her twin daggers. Now both you and Kimmich should have 3 health. Vem, your turn."
"Hit the tab?"
"Hit the tab."
"Hitting tab." Vemnka rolled her d20 and it landed on a 19. "19 plus whatever, I already know it hits."
"That it does," Andre responded. With a flick of his wrist, he knocks over the Tabaxi's pawn and places a cross where it was, he does the same with the Goliath's king. "Wait, why did you do that? I hadn't rolled damage."
"The Tabaxi had one health, there's no feasible way you do zero damage when rolling a dice with no zero on it. Anyway, let's wrap this up, it feels like we've been at this forever. Kimmich, your turn."
Dad sighed a deep whistling sigh. "I'll just roll to attack the Elf." He rolled his two dice, one landed on a 12 and the other landed on a 7, plus the 5 to his hits. "17 and 12. Rolling damage for that 17."
"Roll for both, the Elf's AC isn't that high."
"Really," I asked, bewildered.
"Really. The Goliath had the most AC at 16, but meets it beats it and Kimmich met it in the first round." The clack of dice interrupted him as Dad rolled his two damage die. Andre leaned forward to announce the numbers. "A total of 13. Congratulations, the three of you have just won a skewed encounter of DnD."
"Skewed encounter?"
"The Goliath had 40 health while everyone other than the Tabaxi had 20. The Tabaxi had 17. The Goliath had an AC of 16 while the rest had between 12 and 14. At least one of you should have died. I was betting on Kimmich because I had the Goliath go after him, but the nat 1s kinda stopped that from happening." Andre shook his prosthetic hands and brought them up to his chin. "Anyway, I'm dead tired. Never want to do that again, ever."
"I can't say I'm in the same cruiser as you, I found it quite fun, even with the gruesome descriptions," I said, probably unconvincingly. I did have fun, but it was a lot to take in all at once.
"I had fun too. Just, if we do do this again, try to tone back the predatory stuff. The fighting was fine, but the description was a bit... spot on I think." Vemnka's tail curled a bit as she probably imagined the images Andre described in her head.
Dad only gave a small 'hmph' as he scooted off his chair and went toward our rooms.
"Well," Andre started, "that's about what I expected from a bunch of scared space sheep."
I let out a whistle as Vemnka gently lowered herself to the ground, marched up to Andre, and bopped him on the thigh with all her might.
===================END=TRANSCRIPTION===================

31m 6'0" 250lbs, former smoker, no drinking, dx w/IST(Inappropriate Sinus Tachycardia) which is well controlled without medication, currently taking Lisinopril 20mg for hypertension.
So I've had some labs done and I'm curious and a bit terrified to see the PTHRP low <5pg/ml. My endocrine kept saying we run this test to check for any malignancy. Google is of no assistance as you all know but I can't get away from it. Could any doctor here shed any form of advice on the situation. Please any advice on these labs would be appreciated. Thank you.
I will share the whole lab:
PTH-Related Protein PTH-RP <5 L Reference Range: 11-20 pg/mL
CBC (INCLUDES DIFF/PLT WHITE BLOOD CELL COUNT 12.0 H Reference Range: 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.50 Reference Range: 4.20-5.80 Million/uL
HEMOGLOBIN 15.2 Reference Range: 13.2-17.1 g/dL
HEMATOCRIT 46.2 Reference Range: 38.5-50.0 %
MCV 84.0 Reference Range: 80.0-100.0 fL
MCH 27.6 Reference Range: 27.0-33.0 pg
MCHC 32.9 Reference Range: 32.0-36.0 g/dL
RDW 13.8 Reference Range: 11.0-15.0 %
PLATELET COUNT 364 Reference Range: 140-400 Thousand/uL
MPV 9.7 Reference Range: 7.5-12.5 fL
ABSOLUTE NEUTROPHILS 8220 H Reference Range: 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 2352 Reference Range: 850-3900 cells/uL
ABSOLUTE MONOCYTES 1044 H Reference Range: 200-950 cells/uL
ABSOLUTE EOSINOPHILS 312 Reference Range: 15-500 cells/uL
ABSOLUTE BASOPHILS 72 Reference Range: 0-200 cells/uL
NEUTROPHILS 68.5 % LYMPHOCYTES 19.6 % MONOCYTES 8.7 % EOSINOPHILS 2.6 % BASOPHILS 0.6 %
Comprehensive Metabolic Panel GLUCOSE 96 Reference Range: 65-99 mg/dL Fasting reference interval
UREA NITROGEN (BUN) 16 Reference Range: 7-25 mg/dL
CREATININE 0.86 Reference Range: 0.60-1.26 mg/dL
EGFR119 Reference Range: > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO SEE NOTE: Reference Range: 6-22 (calc) Not Reported: BUN and Creatinine are within reference range.
SODIUM 137 Reference Range: 135-146 mmol/L
POTASSIUM 4.7 Reference Range: 3.5-5.3 mmol/L
CHLORIDE 99 Reference Range: 98-110 mmol/L
CARBON DIOXIDE 30 Reference Range: 20-32 mmol/L
CALCIUM 9.6 Reference Range: 8.6-10.3 mg/dL
PROTEIN, TOTAL 7.5 Reference Range: 6.1-8.1 g/dL
ALBUMIN 4.4 Reference Range: 3.6-5.1 g/dL
GLOBULIN 3.1 Reference Range: 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.4 Reference Range: 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.3 Reference Range: 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 49 Reference Range: 36-130 U/L
AST 20 Reference Range: 10-40 U/L
ALT 33 Reference Range: 9-46 U/L
PTH, INTACT WITHOUT CALCIUM PARATHYROID HORMONE, INTACT 30 pg/mL
Magnesium 2 mg/dl
PHOSPHATE (AS PHOSPHORUS) 3.7 mg/dL

My pup got used to whine close to the door to indicate his potty needs, it was all fine until he started to whine to go out less than an hour later after we got back (at 9 mo he can hold his bladder pretty reliably). I tried to comply with his needs, but in fact he just marks without barely any pee, and then procceed to sniff around the area.
Figured out that could try the bell route. He learned pretty fast, but a few weeks later (now) he's ringing it just to go outside, which completely defeated the role of the bell, so I took it out.
I wonder if there's anything I can make to fix it? Or maybe it's just an adolescent thing to behave like this? Maybe I should retire the bell until he matures, because honestly it's more annoying than the whining.
If I'm out just in front of my apartment on his usual pee spot and just stand still (boring outing), he just whines and paces on his leash range. And then upon returning home he procceeds to whine (or ring the bell) again. I live on the 3rd floor so it's a little cumbersome to just go out and test out those things.
Also disclaimer: There's no health issues, and all his enrichment, scent work and exercises indoors are met, but he's a frustrated greeter and sometimes I'm suspicious that all of this urgency to go out is to see if he can find other dogs being walked. I've been advised, to help regulating his over-stimulation, that I cut walks every other week, but then that's so hard because even potty breaks almost count as walks because he may take up to 20 minutes of going up and down my block.
Thanks for any advice!

Looking for guidance on filing Claim (1st) next week. TIA!!
In Persian Gulf 02Aug90 - 30SEP90 - TERA, Reported Sarin use while ONSTA
Filed intent to file, June 2023
I have Dx and meds.
Do I need to specify primary and secondary?
I have VHA and Civi doc confirming.
Do I also file for Raynauds with pics or wait for Dx?
My list of Diagnoses - most confirmed within a year or so, almost all 5+ to 20 years.
Sorry, the timeline, as best as I can recall.
Nothing prior to service. IN Service: 1990 - Stress-induced asthma 1991 - 6 mos LIMDU s/p fall on ship, LBP, MRI findings. PhysTherapy found bilateral chondromalacia patella, deficit of leg strength Two Psych evals after chewing out CAPT DOC re: heal my back 1992 - 1993 A lot of inhalers and NSAIDS for back pain.
After Honorable: 1997 - VA - albuterol Asthma 2000 - Chronic Rhinitis, Sinusitis, Sleep Apnea Symptoms, Weight gain 2001 - Ride for 9/11 - SD to NYC, Police Escort, Tour Ground Zero still on fire, Numb + Avoidance 2002 - Gout, kidney stones 2004, 2005 - VA - Cardioversions x 2 + OSA CPAP + Hypertension + Borderline A1C @ 6.4, GERD 2006 - CIVI - Anxiety, Asthma, LBP, neck pain, TN, Paroxysmal Afib, CHF 2007 - Pain increased, MDD, Anxiety, Nasal Polyps, common sinus infections, persistent cough 2011 - VA - TIA, Gout+, Hypertension, Kidney Stones, Morbid Obesity 2012 - Divorce w/ profound anger, Isolation begins, Depression +, Lungs feel swollen, SOB 2014 - A1C ~7.0, weight gain, LBP worsens, OSA+CSA BIPAP 2016 - Restless Leg Syndrome, severe asthma, unable to perform job, 50% work 2017 - Nasal Polyps confirmed on MRI, IBS Sx, Shut in, Lost Engagement, Isolation, Max Singulair, Kenalog shot for allergic reactions and worsening breathing. 2020 Back and Neck Pain now CHRONIC, Anxiety Increased, Insomnia, Fatigue, SI, PTSD anger and guilt 2022 - Elevated BNP (confirms CHF), Angiogram for two artery 50% occlusion, PTSD and Insomnia go through the roof as I reduced Percocet from 40 mg/day to 20 mg/day. Psych confirms "compensating behaviors lost during 7 years of consistent Percocet use, Lyrica and Gabapentin both failed as I lost motor control and balance. Lost EOD training buddy to Lung Cancer. Effexor Maxed. Multiuse for rescue inhaler. 2023 - IBS worsens, GERD returns, SI, PTSD rated to 49, Unable to work regularly, physical labor only for 3-5 minutes, walking more than 100 years leads to breathlessness. Add steroid inhaler. 2024 - Afib to Chronic, Start PTSD and MDD counseling with VA

Heart

CAD - Coronary artery disease (SCT 53741008) DBQ + Angiogram + Stress tests
Chronic diastolic heart failure (SCT 441530006) DBQ + echo + Stress tests + Confirmed
Transient Ischemic Attack Apr 9,2011@11:44
I48.20 Chronic atrial fibrillation R79.89- Elevated brain natrluretic peptide (BNP) level 8/2/22

Psych

Depression (SCT 35489007)
Anxiety (SCT 48694002)
PTSD Rated 49, Psychiatrist stated anxiety valid for life risk in Gulf Attack
G47.00- Insomnia Ongoing, Part of PTSD

Neuro

Trigeminal neuralgia (SCT 31681005)
G89.4- Chronic pain syndrome
M79.2 - Neuralgia Part Back Pain

Gut

R10.9- Abdominal cramping IBS - Dicyclomine
K21.9- GERD (gastroesophageal reflux disease) after meds jumped again
R11.0- Nausea Zofran
K59.00 - Constipation Part of IBS

Ortho

M54.5 - Low back pain - CHRONIC 3-8 Naprosyn + 2 Aspirin 325 Daily
M542 Neck pain - CHRONIC 3-8 Naprosyn + 2 Aspirin 325 Daily

Sleep

Obstructive Sleep Apnea of Adult (SCT 1101000119103) Twice confirmed OSA + CSA
J01.01- Acute recurrent maxilary sinusits Twice Daily flushes, 4-6 infections each year
R53.83- Fatigue
G25.81 - Restless leg syndrome confirmed in latest Sleep Study this month
R09.81 - Congestion of nasal sinus Twice Daily flushes, 4-6 infections each year
J309.- Allergic rhinitis - Chronic Twice Daily flushes, 4-6 infections each year

Other

Diabetes Mellitus Type 2 (SCT 44054006) Hyperlipidemia (SCT 55822004)
Gout (SCT 90560007)
Morbid obesity (SCT 238136002) Met with Nutrition team and lost weight

Last PCP noted from my Civilian records:
"These records - Dr. Nichols, MD - Show drug compliance, Constant Pain from Back, Recurring Gout and kidney stones, Development of severe lung issues, Rx History."

Imagery: Prompt: Choose a setting (real or imaginary) and describe it using detailed sensory imagery. Imagine the sights, sounds, smells, and textures to create a vivid scene, just like a painter with words.
Metaphor: Prompt: Compare a personal experience to an everyday object or phenomenon in an unexpected way. For example, "My heart is a compass that always points to the north of your laughter."
Simile: Prompt: Write a series of similes to express intense emotions. For instance, "As brave as a lion facing the storm, as fragile as a petal in the wind."
Rhyme: Prompt: Craft a short poem or lyrics with a consistent rhyme scheme. Experiment with different rhyme patterns (ABAB, AABB, etc.) to enhance the musicality of your writing.
Meter: Prompt: Compose a poem with a specific meter, such as iambic pentameter. Pay attention to the syllabic beats in each line to create a rhythmic flow.
Alliteration: Prompt: Create a tongue-twisting line using alliteration. Focus on the repetition of initial consonant sounds to add a playful or musical quality to your writing.
Assonance: Prompt: Write a passage where the vowel sounds within words echo each other. Experiment with different vowel combinations to create a melodic effect.
Personification: Prompt: Choose an inanimate object and personify it. Describe its actions, thoughts, and emotions as if it were a living being.
Symbolism: Prompt: Select an object or element and explore its symbolic meaning. Connect it to broader themes or emotions in your writing.
Enjambment: Prompt: Write a poem where the thoughts flow continuously from one line to the next without a pause. Explore how this technique can create a sense of movement or urgency.
Repetition: Prompt: Repeat a word or phrase throughout a poem for emphasis. Consider how repetition can enhance the overall impact and meaning of your writing.
Free Verse: Prompt: Embrace the freedom of expression by writing a poem without adhering to rhyme or meter. Allow your thoughts to flow organically, exploring the beauty of formless verse.
Stanza: Prompt: Divide your writing into stanzas to create distinct sections with varying themes or tones. Explore how the organization of lines contributes to the overall structure of your work.
Theme: Prompt: Choose a universal theme (love, loss, freedom, etc.) and explore it through your lyrics. Delve into the nuances and perspectives associated with the chosen theme.
Tone: Prompt: Write a poem that conveys contrasting tones. Explore how shifts in tone can evoke different emotions and responses from the reader.
Connotation: Prompt: Select a word with strong connotations and use it in a poem. Explore the emotional baggage and cultural associations tied to the word within the context of your writing.
Irony: Prompt: Craft a poem with elements of irony. Create situations or lines that convey a meaning opposite to the literal interpretation, adding layers of complexity to your writing.
Allusion: Prompt: Reference a well-known song, book, or historical event in your lyrics. Explore how the use of allusion can enrich the depth and meaning of your writing.
Syntax: Prompt: Experiment with sentence structure to create different effects. Play with word order, sentence length, and punctuation to convey specific emotions or rhythms in your writing.
Diction: Prompt: Choose a specific mood or atmosphere you want to convey and carefully select words that evoke that feeling. Pay attention to the impact of your word choices on the overall tone of your writing.

I was able to get scheduled quickly for a diagnostic colonoscopy which will take place on 6/13. I leave for vacation on the beach about 9 hours from home on 6/15. I’m anxious about the results and how I’m gonna handle the heat/no closely accessible restroom.
My husband said if it’s an emergency I can go in the ocean. I don’t want to do that but I guess I have to keep it as a backup plan.
I figured, because most of my BM urgency and frequency happens in the morning, I should wait until mid-morning or almost noon to go out on the beach. We’re bringing pedialyte freezer pops to stay hydrated (big issue for me recently.)
Does anyone have tips for surviving the beach? It’s the southeastern coast of the US so I imagine temps will be mid 70s to mid 90s or so. I’m gonna bring extra underwear and maybe a couple of bathing suits. Gonna put together an “emergency kit” today.

**Prompt 9:
Walwalün (Yaghan) - Appreciating the Sound of Water in Movement**

Describe a moment when your character appreciated walwalün, the sound of water in movement, and explore the emotions stirred by this auditory experience.
Delve into the settings where walwalün resonates most profoundly for your character, whether it's a natural landscape, a man-made feature, or a specific body of water.
How does the sound of water in movement influence your character's mood and thoughts, and does it hold any symbolic significance in their personal journey?
Explore your character's relationship with the natural world and water, considering whether walwalün serves as a source of comfort, inspiration, or reflection.
Reflect on moments when your character intentionally seeks out walwalün, exploring whether it serves as a form of meditation, relaxation, or connection to nature.
Consider the impact of walwalün on your character's creativity and mindset, examining whether the sound of water in movement becomes a muse for artistic expression or introspective thought.
How does the cultural or spiritual context of your character influence their interpretation of walwalün, and are there rituals or practices associated with this appreciation of water's sound?
Explore how walwalün intersects with your character's memories or significant life events, and whether certain sounds of water trigger specific recollections or emotions.
Can your character find solace or clarity in the consistent presence of walwalün, especially during challenging or transitional phases of their life?
Envision a pivotal scene where walwalün becomes a central element, influencing your character's decisions, relationships, or contributing to a significant turning point in their narrative.

**Prompt 10:
Torschlusspanik (German) - Fear of Diminishing Opportunities**

Recreate a moment in your character's life when they grappled with torschlusspanik, the fear of diminishing opportunities, and explore the emotions that surged during this existential anxiety.
Delve into your character's perception of time and aging, considering whether specific milestones or societal expectations contribute to their fear of missed chances.
How does torschlusspanik influence your character's decision-making process, particularly in situations where time-sensitive choices could impact their future opportunities?
Explore your character's aspirations and whether they feel a heightened urgency to achieve certain goals before the window of opportunity closes, intensifying the fear of diminishing chances.
Reflect on how societal or cultural factors exacerbate your character's experience of torschlusspanik, and whether external pressures shape their fear of missed opportunities.
Consider moments of empowerment or liberation within the fear of diminishing opportunities, exploring whether your character can turn this anxiety into a driving force for positive change.
How does the fear of diminishing opportunities impact your character's relationships, both in terms of personal connections and professional pursuits?
Delve into your character's perspective on aging and the passage of time, exploring whether they view each birthday or life stage with a heightened sense of anxiety.
Reflect on whether torschlusspanik is a recurring theme in your character's life or if it becomes more pronounced during specific phases or transitions.
Envision a crucial scene where torschlusspanik takes center stage, driving your character's actions, influencing their relationships, or shaping the overall trajectory of their narrative.

For starters, I'm a dispatcher a year and a half almost two years in - in September. Only fully released for about a year and some change.
I feel I do everything well , but I have tended to struggle with cardiac calls. Our center uses EMD, so if you are familiar with how that works, I am sure you are aware of how strict , but useful it is to medical calls.
I have gotten a call review on a cardiac call before and I had expressed to my QA boss that I would benefit with trainings and more practice with cardiac calls. They assigned me several IAED classes that focus on cardiac calls and that has helped me improve tremendously since. However every time I take a cardiac call or something that leads to CPR being needed , I tend to feel like I have done something wrong or could have done better, and that it is my fault the patient dies. No reading articles and online classes can prepare you for actual calls .
Just the other day I had a caller who was reporting her 18yo nephew was unconscious and the mom was doing cpr . I Did ask if she needed CPR instructions to be read to the mom and she said not right now she's familiar because the pt had cerebral palsy. When I asked the caller if the pt was laying on his back , she told me that he was in a passenger seat in the car and was lying flat . Later on in the call, I asked how the CPR was going and she advised that the mom had stopped because she was crying . I immediately told the caller to take over for her and read the cpr instructions as written and told her they were doing a good job to help him until the responders got there.
Once ems and fire got there they worked on him for a while and ended up calling him as deceased. This made me worry due to my anxiety and past struggles with cardiac calls. Later on a officer called into the center for a recording of the 9-1-1 call. This only elevated my fears that I had done something wrong . I listened back to my call and I went through protocol correctly and reassured myself that I did all I could do. My co worker also assured me of same and said that they may have just been requesting the call due to the patients age or per their own protocols (neighboring police agency).
This leads me to the call I had tonight which really has me worried or more so upset that I could have done something better .
Tonight I took a call , lady called in for her husband . I noticed off hand that she was a Spanish / English speaking caller, but she seemed to be answering good enough in English to proceed without switching her to a language line and I was able to go ahead and get ems and fire enroute emergency traffic . We also have a Spanish speaking call taker in the room as well, but she was on the phone and has a trainee that was as well. I went ahead and continued to process the call due to the urgency of the symptoms. (she also never requested for a Spanish speaker). The wife was answering just fine and had no troubles explaining to me that she felt her husband was having a heart attack . One of her children came in the room as well and I assume the caller had me on speaker phone because when I asked the case entry questions "is he awake , is he breathing? " they both said yes. I continued with the call and the child began answering the questions for me very well, and I made sure to let the child know they were doing a good job and we were getting help to him quickly . He or she spoke English so they were able to answer for me. At one point it was answered that he has history of heart attack and then I heard several other children or family members come into the room .
They all started to chatter and suddenly began screaming . I tried to get one of their attentions and one of the children said he just stopped breathing and that their older sister started cpr , they then told me that he has a pacemaker but due to the heightened emotions of all the callers in the room - the person responding to me couldn't think of the word pace maker off the top of their heads , I understood what she meant because she said "The thing that shocks your heart" . I continued to try to see if they needed cpr instructions and they all began panicking and speaking to each other in Spanish and not listening to me no matter how hard I tried to get one of them to answer to me . My coworker finally got off of the call she was on and I told her what was going on and she said to let her speak to the mother who would be able to better give her information in Spanish and in my logic- to not give the kids any more stress than they were already facing . My coworker took over the call and was able to talk one of them into taking the CPR instructions once one of them came back to the phone , they switched out who was doing it ,and then the caller just abruptly disconnects - not even telling us that fire or ems had gotten there. Ems and fire got on scene and continued cpr with ROSC (coming back to) several times and I was just shaking in my seat feeling terrible , Like I could have handled the situation better. I was just worried this dad was going to die . I know he had previous health issues before , but it still bothered me. Also I know that switching them to the language line would have been very tedious and if you've ever done so , administering cpr over the language line is not very useful . The male finally came too and was rushed to the nearest hospital but I know he also coded while enroute to same -but had rosc again before getting to the hospital .
After the call, my coworker who helped take over the call, seemed to be aggravated with me . I know she was probably just bothered by the emotions of a cardiac call like everyone else is after these calls , but something just made me feel like she thought I did something wrong or that she was just po'd in general . (She's a shift assistant supervisor and already has some sort of one sided beef with me (I can explain later) - our main shift lead was out today )
I know that I'm probably just having anxiety over this but these are serious calls and we are responsible to make sure that we give the callers the best service and life saving instructions so if there is something I can do better or improve on, I would like to know . I have emailed my QA boss who handles these calls and reviews them . I asked her in my email to review it for me and if she could help me figure out if there was anything that could be done better in the future for a situation like this.
Thanks for coming to my rant . Do any of you also have trouble with situations like this ?
Please consider DM ing me if your are interested in sharing any of your stories to help assist me with my research novel " I AM NOT 10-4" . In this novel , I will touch on the many things that dispatchers endure such as stress , burnout, and what its like to deal with stressful calls.
You are appreciated. Thankyou !

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Long read
I had this originally written under a previous post asking about potential health effects of Quetiapine in this sub. I thought it might be a little much to blow up on someone else’s question. So here is my (long ass) experience and current investigation underway with my rheumatologist in Boston who was an adjunct professor and graduate from Harvard with an expertise in pharmacokinetics.
This will be a dumbed down version the best I can explain as layman with a mere masters degree in physical therapy. While I have a strong grasp of the concepts and language, I may get verbiage or premises incorrect but I believe this will read mostly correct. If you’re a medical professional or chemist, feel free to correct me. Im no writer and I’m sure this will be evident by poor grammar and run on sentences but I did try to do a quick proofread. It’s Reddit though, so…whatever lol.
This is a super individualized account to my neurobiology. Much of it will read as though I’m trying to scare off anyone from ever taking this medication. If you get through it, you’ll see that my doctor’s theory mostly shows the opposite, and the safety profile is extremely good. The people at the highest risk of suffering my fate, that is if he is even correct because this is still just a theory(but well backed) are people in the large cohort of patients being prescribed Quetiapine off label for sleeplessness or “insomnia” as a primary diagnoses.(Spoiler: insomnia is not a real diagnosis, it’s a secondary symptom and why the manufacturer warns physicians against prescribing for sleep).
Seroquel destroyed my life. Prescribed by a “Noctor”(mid level nurse playing with shit she doesn’t know thinking she’s as smart as a doctor) an insane dose of 300mg a night for simple nighttime induced anxiety that messed with my sleep.
This was after suffering an issue where I was on the road and didn’t sleep at all for 4 days. I was really struggling and my employer paid for me to see one of the top psychiatrists on the planet that works specifically with people in my industry(entertainment). We happened to be coming up for a stop in Nashville(where she practiced) and they setup the appointment. I had 6 hours with her where she walked me through the fallacy of insomnia as a primary diagnosis, and that I needed to find the physical or psychological root cause. 90%+ of “insomnia” is just a secondary symptom of mild anxiety with a nighttime onset. That is what she diagnosed me with. Simple anxiety that was triggered at night because my career was so mentally vigorous and non stop that all anxiety was building up with no where to be expressed other than the only time my mind wasn’t occupied by work…laying in bed.
She sent my diagnosis back to my primary in New England and wrote me a script for 8mg of Xanax a month with instructions that I had 2x1mg doses per week to utilize as an emergency med but the goal would be through therapy and self moderation of work to utilize the medication as little as possible.
When I got home from my work trip the only appointment I could get was with the Noctor as my primary physician was booked out for almost 2 months. She looked at the diagnosis from a world class psychiatrist and inserted her own biases about Xanax use under any circumstance being extremely dangerous. Even as an emergency or rescue medication taken a couple times a month. So she choose to nuke my fucking brain with a high daily dose powerful antipsychotic for some night time anxiety.
For a year it was fine other than a little weight gain. Wasn’t too bad for me though because I worked 16+ hours a day on the road 9 months a year.
Then the nightmares started. Like insane, traumatic, horrifically vivid nightmares that would make Stephen king blush. I’ve seen every person and pet I’ve ever know or loved, including myself murdered gruesomely in the most gorey ways in realistic acts of violence, accidents, as well as supernatural monstrous hell fuel.
I’d wake up soaked, covered in sweat and my back and neck would be sore from my entire body being contorted and stiff in terrible positions whilst waking up completely hypertensive due to the vivid hellscape I just awoke from that was indistinguishable from reality.
I went back to her and begged her to change it because I was no longer feeling like I was sleeping. I was just going from one world to another and waking up feeling like I was just in a car accident. She told me it was the only thing she prescribes for sleep because everything else is addicting and dangerous. So I tried to tough it out but after a few more weeks couldn’t take it anymore. I got another appointment and told her I was done whether she liked it or not. I wasn’t getting any rest and I’d wake up in pain like I was hit by truck. She then essentially threatened me. She told me the only way to get off it was to see the psychiatrist at my practice and told me if I went anywhere else she would flag me as a drug seeker. The first date available with that psychiatrist…6 months. So I set an appointment as early as possible with my actual physician(nearly 2 month wait) and figured I’d start weening myself off and by the time I saw my doctor I would be fully off or mostly off.
About 2 days later(I hadn’t even reduced my first dose yet so I was still on 300mg) I was hospitalized. I woke up from my normal nighttime alternate universe of horror completely immobile from my armpits up. I wasn’t numb, but I woke up with my head kinked under my right arm and bent almost completely around. Any movement felt like my spine from my upper thoracic all the way through my cervical spine was going to snap. My wife had to call an ambulance because it was not loosening up like it normally would. While the paramedics tried to board me from my bed I went into shock from the pain and went unconscious.
I woke up in the hospital a few hours later where I learned the doctors had to pump some drug into me that essentially made all of my muscles go completely limp in order to move me out of the position because my muscles were so rigid they couldn’t untwist me. The ER doc said he had never seen anything like it outside of some extreme situations of rigor mortis when someone was found dead in an awkward position and the body locked into that position.
Even once released from that position I felt like I had a knife in my neck. The ER called into my primary physician to update them and they moved my appointment up. In the days that followed my neck only got worse. I couldn’t stand, sit or lay in the same position. I obviously stopped Seroquel immediately. I spent all day flat on my back crying with my wife encasing me in and changing ice packs every 15 minutes. I was ready to kill my self the pain was so bad.
When I saw my doctor a couple days later we were going over my records and I emphasized this was a direct result of the Seroquel that I begged to come off several times because of the side effects and I had learned that even the drug manufacturer didn’t approve of it being used off-label for sleep. She was shocked I was being prescribed 300mg for sleep. I asked her that if she was shocked, why would she approve it considering she was the supervising physician for the noctor that prescribed it to me? She showed me the offices internal notes and the noctor has diagnosed me with mania and disassociation.
Like, WTF!?
There was no record in the practices notes of the diagnoses and recommendations from the psychiatrist I saw in Nashville other than “patient saw a “pill doctor” out of state”, “says he has “anxiety”.
Reading through her notes it essentially accused me of psychosis and drug seeking because I saw a doctor out of state that prescribed me a medication she didn’t agree with.
On my doctor’s end in her oversight of her nurses prescribing she just saw that she was prescribing a patient Seroquel for manic episodes, which is a standard course of action. She agreed that this was a horrible misjudgment, viewed the physical copies of the notes I brought home from Nashville, and immediately changed me to that physicians plan of Xanax as an emergency/rescue med vs 300mg of Seroquel daily.
It was too late though. The pain in my neck never went away. I couldn’t move, I was completely bed bound. The pain in my neck felt like I was wide awake whilst someone dissected my cervical spine with a rusty box opener. They sent me to “interventional pain management” where they then did more non-fda approved “healthcare” by repetitively injecting corticosteroids into my spine.
It only got worse and worse. The pain began to spread from my cervical spine, down into my thoracic spine. I started losing feeling in my arm. Then it was neurological medications like gabapentinoids, muscle relaxers, high dose NSAIDs, tricyclic antidepressants, physical therapy, cognitive behavioral therapy etc…within 8 months that noctor was no longer employed at the office(I don’t officially know if it was from her destroying my life).
After about a year there was still no answers. I lost my job that I had busted my ass for over a decade climbing the industry ladder after getting and advanced degree, and was on the verge of losing my house because I was still completely bed bound 90% of the day.
My doctor out of desperation and lack of answers starts me on narcotic pain management. I had never once touched opioids outside of anesthesia inpatient surgeries related to sports injuries growing up. I was staunchly against the use of opioids outside of that setting. Other than some moderate cannabis use after college(when I was no longer being drug tested for the first time in 6 years) I was pretty brain washed by the drug war zealots. Now I’m a pariah. Both doctors and people in my social circles keep me at an arms length because people drank the koolaid and believe anyone taking an opioid must be a raging addict sucking dick for heroin.
I’ve managed to claw back and slow down the total collapse of my entire life because my pain is now controlled to about 60ish% by pain meds while I go doctor to doctor trying to figure this out. By working as a part time consultant in my industry I’m making just enough money to stop complete asset loss but I’m still eating into my retirement and investments. If it wasn’t for the fact that my wife makes a decent salary we’d already be homeless. Even then we’re hemorrhaging money and are likely going to have to sell our house. At 32 I was on track to retire by 50 and travel the world. Now at 37 I don’t know if I’ll be alive by this time at next year as the inflammation and connective tissue deterioration runs rampant.
Doctors absolutely hate and refuse to try and pin serious medical conditions on bad medical professionals or bad medication. I’ve been through every major “world famous” hospital system here in Boston and they’re willing to look for the answer everywhere accept where I’m telling them it started. Until a few months ago.
I hired a high profile private patient advocate. A woman who is a former internal medicine expert that was the lead in a department at Brigham with a PhD/MD from Harvard and her law degree from Cornell. She found me an expert here in Boston that is a rheumatologist who investigates pharmacokinetics. He produced several redacted papers by the patent holders on Seroquel that show them shutting down the research by a hired lab that found Tumor Necrosis Factor spikes in high doses of Seroquel administered to mice with normal neurological function. 3 other labs confirmed the research and wanted the medication held for retrial in humans.
TNF when not properly regulated by the immune system causes a cytokine storm attacking healthy tissue without the presence of disease/damaged tissue. This is the foundation of most autoimmune diseases.
Seroquel regulates various neurotransmission and endogenous processes in the brain when they are not at their normal levels. Even then the science isn’t perfect on it so often an SSRI is prescribed along side because SSRIs are better understood and it’s kind of a protection from the unknown actions of the Quetiapine(Seroquel).
If those neurotransmitters are functioning correctly and neurological function is fine, introducing something like Seroquel in high doses at constant intervals can be incredibly dangerous.
This is where the black box warnings and requests for bans from the manufacturer of seroquel about off label prescribing come from. They only reported redacted and halted research on TNF production increase associated with the drug because they only ever confirmed the research with mice.
This rheumatologist has essentially shown to me with pretty indisputable evidence that I’ve likely developed a severe medication induced autoimmune disease that is rapidly destroying the connective tissue in my spine and is now jumping to organs. It falls outside the diagnosis of any single autoimmune disease and can only really be classified as MAS(multiple autoimmune disease). Because the research papers are all heavily redacted and were never entered into peer review for final patenting and fda approval there is no case or action for me to bring.
Furthermore seroquel has a pretty high safety record because it’s statistically more normal to have an imbalance of the neurotransmitters that it regulates which means it’s rare to cause the reaction the research found with the mice. Most people have some form, even if mild, imbalance that most often goes without symptoms. But the manufacturers did know the consequences of introducing a high dosage of the compound to a perfectly balanced brain.
I fell into a perfect storm. My neurotransmission was such that a small dose of Seroquel daily likely wouldn’t have hurt me but it was as close to equilibrium that flooding it with a drug that regulates neurotransmission that I exhibited the same outcome as those mice forcing my immune system to drive up TNF production. There is a well known list of medications that can cause autoimmune diseases and the way the drug was patented and approved it escaped this labeling given the uncommon instances of the phenomenon.
I am now in the phase of trialing every biologic/TNF inhibitor known to man to try and get it under control before it completely disables me, or jumps to a vital organ and kills me.
This is still only a theory by an extremely educated expert in the field as autoimmune diseases and tumor necrosis factors are only recently in the last couple of decades becoming more understood. We got a more substantial confirmation that he is correct over the winter when I got my first case of Covid19. I rarely get sick. I am an extremely healthy person that exercises regularly(as much as possible through my pain now) as a former division 1 athlete and eats super clean and balanced. This was the first time since this began to see what my immune system did under duress.
My pain dropped by easily 50%. Meaning my immune system had something to do other than attack and inflame the healthy tissues in my joints and organs. While I felt like shit of course, my neurological pain dropped significantly. Within a week of recovering I had to increase my pain meds back to normal as everything became inflamed again.
The entire point of this rant is this: Seroquel is extremely dangerous…to a small population of people. This isn’t uncommon of most pharmaceuticals. It is a cautionary tale about the off label prescribing of this drug for sleep, and sleep only. DONT ALLOW IT TO HAPPEN TO YOU.
If a psychiatrist, neurologist, or behavioral therapist has well documented diagnostics and evaluation that leads them to believe you have a significant neurological imbalance that leads to a true psychiatric diagnosis you will almost certainly be just fine with Quetiapine.
Unfortunately Seroquel is the most prescribed off-label sleep medication on the market. It needs to be stopped. The primary indication for Seroquel cannot be “insomnia”. The manufacturers tried to hide the pharmacokinetic reasons as to why, but they did black box it and request physicians not to prescribe it for such. Read the insert. Back, neck, and joint pain are all warnings to speak to your doctor immediately and this is why.

Icd 9: hypertensive urgency

Ripping my hair out over “trying” visible!!

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