The FDA approved belimumab (Benlysta; GSK) as a 200 mg subcutaneous injection for patients aged 5 years and older with active systemic lupus erythematosus (SLE) who are receiving current therapy. With this approval, pediatric patients can now receive treatment at home.¹

The FDA approved belimumab (Benlysta; GSK) as a 200 mg subcutaneous injection for patients aged 5 years and older with active systemic lupus erythematosus (SLE) who are receiving current therapy. With this approval, pediatric patients can now receive treatment at home.¹

The FDA approved belimumab (Benlysta; GSK) as a 200 mg subcutaneous injection for patients aged 5 years and older with active systemic lupus erythematosus (SLE) who are receiving current therapy. With this approval, pediatric patients can now receive treatment at home.¹

Welcome to Skin Secrets by Dr. Greta McLaren, your premier destination for rejuvenating cosmetic treatments in the Port Charlotte, FL area. At our medical spa, we specialize in providing expertly administered Botox and dermal filler treatments designed to enhance your natural beauty and restore youthful vitality to your appearance.
Led by the renowned Dr. Greta McLaren, our team is committed to delivering personalized care in a welcoming and professional environment. Whether you’re looking to smooth out fine lines and wrinkles or add volume and contour to your face, our state-of-the-art services are tailored to meet your individual needs and ensure optimal results. Experience the art of aesthetic enhancement at Skin Secrets and discover how we can help you feel confident and radiant.
Message Skin Secrets today or call us at [239-800-SKIN(7546)](tel:2398007546) to schedule your complimentary consultation.

Dysport®

Like Botox, Dysport (pronounced “dis-port”) is a type A botulinum toxin, a highly refined protein commonly used to relax muscles and inhibit sweating. Studies have shown Dysport to work just as well as Botox and may last longer.

BOTOX®

Skin Secrets by Dr. Greta McLaren applies advanced injection techniques that also lift and raise the brows, widen the eyes, soften lip lines, turn up the corners of the mouth and treat neck wrinkles. By starting BOTOX® early, you can prevent lines from becoming permanently ironed into your skin. BOTOX® can also be used to treat excessive sweating.

Juvéderm®

JUVÉDERM® is the #1 selling collection of hyaluronic acid fillers in the U.S. Each product in the JUVÉDERM® Collection of Fillers adds volume to a different area of the face—without surgery. All JUVÉDERM® fillers are smooth, crystal-clear gels that are administered by injection in Skin Secrets by Dr. Greta McLaren.

Radiesse

Radiesse and Radiesse (+) are dermal fillers that are FDA-approved to smooth moderate to severe facial wrinkles and folds, such as nasolabial folds (the creases that extend from the corner of your nose to the corner of your mouth). Radiesse is also used for correcting volume loss in the back of the hands.

Restylane

The Restylane family of products is a brand of hyaluronic acid dermal fillers, which includes Restylane Silk, Restylane Lyft, Restylane, Restylane Refyne and Restylane Defyne. Each is a clear gel formulation of hyaluronic acid specifically formulated to act like your body’s own naturally produced hyaluronic acid. Each Restylane product is designed for a specific purpose.

RHA®

The RHA® Collection of resilient hyaluronic acid (HA) fillers includes RHA® Redensity™, RHA® 2, RHA® 3 and RHA® 4. RHA® Redensity™ is indicated for injection into the dermis and superficial dermis of the face, for the correction of moderate to severe dynamic perioral rhytids in adults 22 or older.

Xeomin®

Xeomin® is made through a unique precision manufacturing process that isolates the therapeutic component of the molecule and removes the complexing/unnecessary proteins that don’t play an active role in treatment.

Premier Medical Spa, and Anti-Aging Clinic near Port Charlotte, FL

When you’re searching for a premier, upscale MedSpa experience, look no further than Skin Secrets near Port Charlotte, Florida. Our experienced team – led by Dr. Greta McLaren – specializes in minimally invasive, non-surgical procedures and treatments customized to your personal needs and goals.
For over 30 years, Dr. McLaren has undergone extensive training in both cosmetic dermatology and laser surgery. She is a laser Surgeon and aesthetic medicine specialist who is considered an expert and has been invited to teach her aesthetic skills nationally to other physicians throughout the United States. She is a member of the American Society of Laser Medicine and Surgery, and American Society for Photodynamic Therapy.
Message Skin Secrets today or call us at [239-800-SKIN(7546)](tel:2398007546) to schedule your complimentary consultation.

SIMLANDI is the first interchangeable high-concentration, citrate-free biosimilar to Humira®
PARSIPPANY, N.J. & REYKJAVÍK, Iceland--(BUSINESS WIRE)-- Teva Pharmaceuticals, a U.S. affiliate of Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA) and Alvotech (NASDAQ: ALVO), today announced the availability of SIMLANDI (adalimumab-ryvk) injection in the U.S., as an interchangeable biosimilar to Humira for the treatment of adult rheumatoid arthritis, juvenile idiopathic arthritis, adult psoriatic arthritis, adult ankylosing spondylitis, Crohn’s disease, adult ulcerative colitis, adult plaque psoriasis, adult hidradenitis suppurativa and adult uveitis.
“We are proud to make SIMLANDI available in the U.S. to patients and providers,” said Thomas Rainey, Senior Vice President, U.S. Market Access at Teva. “Biosimilars create opportunities for cost savings across the healthcare system, and SIMLANDI’s launch now offers the first citrate-free, high-concentration biosimilar to be designated interchangeable to Humira in the U.S. market. We will be working with payors to ensure access to SIMLANDI, as well as the six other biosimilars we are committed to bringing to market by 2027.”
SIMLANDI is approved by the U.S. Food and Drug Administration (FDA) as the first high-concentration, citrate-free biosimilar to Humira with interchangeability exclusivity for the 40mg/0.4mL injection. While both low-concentration and high-concentration strength biosimilars of Humira are marketed in the U.S. today, nearly 88 percent of U.S. prescriptions for adalimumab are for the high-concentration presentation.1
“It is a great pleasure to be able to offer U.S. patients access to SIMLANDI, the only citrate-free, high-concentration interchangeable biosimilar to Humira. We look forward to increasing the availability of cost-effective quality biosimilars in the U.S., as they can be an important contributor to reduced inflationary pressure for healthcare providers and patients,” said Anil Okay, Chief Commercial Officer of Alvotech.
Teva and Alvotech entered into a strategic partnership for the exclusive commercialization of five of Alvotech’s biosimilar product candidates in August 2020, and in July 2023, the collaboration was extended to include two additional biosimilars and new presentations of two previously partnered products. Alvotech handles development and manufacturing, while Teva is responsible for the exclusive commercialization in the U.S., which leverages Teva’s experience and extensive sales and marketing infrastructure. SIMLANDI is the first biosimilar launched under the strategic partnership, and in April 2024, the FDA approved SELARSDI™ (ustekinumab-aekn) injection for subcutaneous use, as a biosimilar to Stelara®, for the treatment of moderate to severe plaque psoriasis and for active psoriatic arthritis in adults and pediatric patients 6 years and older.
FULL RELEASE: https://ir.tevapharm.com/news-and-events/press-releases/press-release-details/2024/Teva-and-Alvotech-Announce-SIMLANDI-adalimumab-ryvk-Injection-Now-Available-in-the-U.S/default.aspx

Hi all, looking for some advice on pain management and what to ask my doctor for because I'm in near constant agony.
So, a few years ago I injured my back at work, at the time it was just back pain and no sciatica and it cleared up after a week or so of bedrest and because I was young and broke I just rushed back to work without really looking deeper into the problem, or seeing if I could get workers comp. Since then I've had recurring flare ups where I'll be doing something and my back will 'pop' and then the pain will come back. This was so bad that two years ago I quit my job (I worked at a bookstore, lifting heavy books was the whole job) and took a year off to try and recover.
By the end of that year I was feeling really positive, I had occasional aches but no re-injury and hadn't for roughly six months, and because my partner and I could no longer afford for me to be off work (that cost of living crisis, am I right?) I got a new job in a call centre.
Then just as I was starting my new job I had a small sciatica flare up, first back injury in over six months and it came with extra bells and whistles and I was devasted, especially because I could not afford to not start this new job. Though at the time that flare up was so minor that I pushed through it. I went to the ED to be safe because my right foot had gone a little numb, I had no associated back pain and when I'd wake up in the morning I'd get muscle cramps in my foot for about 30 minutes. It was really manageable pain. At the hospital they x-rayed me and told me it was likely a disc protrusion and not anything like diabetes. I am overweight so I was worried this was the issue but my blood sugar levels were normal and so they recommended I get an MRI and I went to a PT and continued my regular medication or Naproxsen 500mg and a paracetamol/codeine painkiller also 500mg and after about three weeks the numbness went and I was fine again.
Fast forward to three weeks ago and I hurt my back just sitting down for work one day, first time since this sciatica issue in my foot and again because money is very tight for my partner and I, we're living paycheck to paycheck basically, I pushed through the pain to work for the rest of the week. I regret this so much as by the end of the first week, instead of back pain I woke up with terrible pains down my right leg.
It started off as maybe a 3 or a 4 in pain so I rested in bed and on the couch watching TV, sticking to my usual meds but at the end of the week I had to go to the ED because the pain was getting so intense I was struggling to sleep more than 3 hours a night, there was no position I could lie in that was pain free and now I was starting to feel like I'd shattered my ankle any time I tried to walk anywhere. It was awful.
In my first ED visit they gave me a anti-inflamatory injection and a script for 100mg of slow release tapentadol and that was really helping. I saw my PT again and was taking a much more frequent course of my naproxen/codeine cocktail. I was still having rough nights but the days themselves would be mostly pain free, enough for me to relax and nap etc.
Then last Thursday I made the pain so much worse trying to go to the bathroom and I had to go to the ED again. They gave me so many painkillers but nothing worked I was at a constant 10 overnight until I managed to finally relieve myself. The constipation was making it SO bad. Since then I haven't been able to really get the pain down below a 6 or 7 and most of the time, esp through the night it's a 9 or 10. I'm exhausted and I can barely sleep. I dread it honestly because now even when I nap during the day I wake-up in agony.
I need to get on top of this pain but I don't know what to do. Its driving me insane and I'm so worn out already, its making me very depressed. I know recovery will likely be more weeks still, which is stressful enough as is because I don't have any sick leave and because this is from a pre-existing injury I let my workplace know about I don't think I can claim workers comp either. I'm still in probation too, that's ending next week and my manager has been so lovely and says she'll fight for me but its still making me so nervous. My partner and I took on more financial responsibility because I was working again and if I lose this job we'll be in debt and so much worse off than before.
At the moment I'm taking 1000mg of Naproxen, once per day and then 100mg of fast action tapentadol every for hours with 1500mg of paracetamol and its having no impact on the pain whatsoever. I'm seeing my doctor later today. What medication can I request so I can at least get some sleep, or start actually walking around? I can walk barely more than from my bed to the microwave to heat up the heat pack I'm using. Any suggestions will be helpful please I'm desperate.

From Andrew Huberman's YouTube Channel:
Dr. Gary Steinberg: How to Improve Brain Health & Offset Neurodegeneration
The most relevant parts:
1:18:47 - 1:19:50
Steinberg: Actually that was the initial notion 20 years ago when we started doing this, was that these cells you put in, these exogenous cells you inject become neurons and astrocytes and oligodendrocytes, all the cells in the brain, and that the neurons reconstitute circuits. That is not how they work. The way they work, and this is why it may not matter what particular type of stem cell you put in, the way they work primarily is by secreting very powerful proteins, molecules, growth factors that promote native recovery. So they promote angiogenesis, they promote native neurogenesis, endogenous gliogenesis, synaptogenesis, but the main benefit may be that they modulate the immune system. That's what we're finding. So by modulating somehow the immune system in the brain they are able to induce plasticity and recover function.
1:38:16 - 1:45:16
Steinberg: There's a lot of Hope for it. I mean we're engaged, we're just finishing a trial, a first-in-human trial at Stanford using cells we developed in my lab 20 years ago. It took us 20 years to prove that they were safe, effective, didn't cause tumors, and the study is looking very promising. It's a phase 1 study and we're making plans to do a phase 2 study with control patients, which you always want to do, but despite the hope there is still a lot of hype. And I think it's very important to be careful about getting therapies that are not proven.
Huberman: Yeah, and while we wouldn't want anyone to take any kind of unnecessary risk, you know, to me anyway this goes back to the beginning of our conversation that there's something very different about a knee from the brain ,right? I'm not saying go get stem cells injected into your knee, but should you be the sort of person that wants to do that because you feel that's within your rights, you know. Again, I don't tell people what to do, and you go to a clinic, they get stem cells or I don't know, they take stem cells from some source and put them into your knee, I mean that's a very different situation than injecting into the brain.
Steinberg: Yes, but you know, what some of the approaches to treat diseases of the brain or injuries to the brain are not injecting directly into the brain. They are injecting intravenously or intraarterial, threading a cath up as we discussed and injecting in the brain. Those cells it turns out don't even get into the brain and the idea is that in some of the better studies that have been done in animals that they work by modulating the immune system systemically. Those cells get trapped in the lung in the spleen which people describe as bioreactors and modulate the immune system which does make some sense. As I say, we think one of the main benefits of these stem cells is that they modulate the immune system and that helps with plasticity in the brain. But even intravenous delivery can be dangerous to the brain.
Huberman: Yeah, this is an area that we will spend a lot more time on during this podcast. Despite what you just said I think the data I've seen from your laboratory, and as you told me there's a trial that's finishing up now that features those data, or that is where those data arrived from rather, are really impressive. I mean some people who were largely immobile or aphasic, they couldn't speak, in some cases are able to speak or move. And that's really remarkable, it's really exciting, so I think that the future of stem cells in stroke therapy is pretty bright, at least from where I said.
Steinberg: Yeah, we don't want to oversell this but some of the results in certain patients are remarkable. I mean the patients and their families has changed their lives. If you see them before and after it's almost like a miracle. Others are not as impressive but so far in our trial, and we've treated 17 of the 18 intended patients, almost all the patients have recovered to some extent and many of them have improved in a meaningful way if you use certain scales. So again, we want to be cautious. We're going to do a prospective randomized blinded controlled study, and that's the way it should be done, and if that's positive it would lead to a phase 3 larger study, again, blinded controlled and if that's positive then it would lead to commercialization FDA approval. It's a long process. I've spent 23 years and more than $46 million in grants and philanthropy getting it to this stage.
Huberman: Wow. That's a lot of time and a lot of money. Amazing.
Steinberg: That's the way science and translation to clinical medicine is.
Huberman: I'd be remiss if I didn't ask what are some of the things that you think could accelerate that process, or is that just the slow iterative process that is science in medicine? I mean for instance if there was five times as much money, would the science progress at five times the rate? Probably not.
Steinberg: No, but money is a factor. It's not the only factor. The FDA is appropriately very cautious. I think other countries, the equivalent of the FDA moves things along a little quicker especially for therapies where there's no other treatment. So I think those factors are important and would accelerate it. I think greater collaboration with industry and promoting more academic industry kinds of relationships would help because the government agencies do not provide enough money to do the final stage. You know, there's called this Valley of Death where you get initial encouraging data, even clinically, but you can't move the hurdle to get it into FDA approval because of money in some cases. I've seen as an example, a number of very good stem cell therapies not make it because the companies went bankrupt. The board of directors of the company felt the results were good but not good enough and they pulled the funding. So this is a whole area which I was not well informed of until I got into this, of how you, you know, move through the FDA and how, you know, work with industry. I haven't formed a company yet but I'm going to have to because for the next trial... this trial I was forunate to get a grant from CIRM, California Institute for Regenerative Medicine, of $12 million.
Huberman: That's taxpayer dollars.
Steinberg: Exactly.
Huberman: Great use of taxpayer money putting into really forward thinking research.
Steinberg: But the next trial, and our results are good enough that we probably will only need - if we do a statistical power analysis - 69 patients. Initially we thought we'd need 170 patients but the results keep getting better and better so now it seems we would only need about 69 patients, that will cost at least $45 million and as the trials get larger even more. So yeah, we need to figure out a better way to allocate money to make these advances.
Huberman: It sounds like a company or some role of industry is going to be necessary.

In one hour my MS nurse will be here to show me how to take my first Kesimpta shot. I don’t know how i feel about it. I know it’s the best thing for me but I’m pretty sad and a bit scared. That’s it. That’s all I have to say. Just needed to put it out there.
Edit to update: Nurse was very kind and explained everything well. No problem doing the actual injection but once she left I had a little cry. I think this is mainly for the symbolism that having this injection makes it real what I’m going through.
I appreciate all the engagements and kind words. I’m going to get in bed for a bit now as I feel tired from the whole experience. Fingers crossed for very little reactions x
EDIT/UPDATE 2: Well it was quite a ride. I initially got a couple of hours where the emotions settled and I felt a bit tired, but that was to be expected after not really sleeping properly for the previous days. I had some food and started watching some tv to try and distract myself and was feeling like I might have got away with it but no.
Hour 3 after taking the shot and I started to get mild aches and a headache. I couldn’t concentrate on the tv so I thought I’d just close my eyes and try and sleep. No such joy. The pain really amped up and I’ve never had such intense body aches and chills. I was literally screaming out ‘oh f**k’ over and over. It was all I could do to make it to hour 4 when I could have some pain killers. I hit the codeine and paracetamol and within 15 mins the pain subsided and I passed out.
I woke up 2 hours later sweating and still in a fever but no pain which I was happy about but within the hour it came again as strong as before. I did the same routine again, waited till I could have pain relief then passed out. I had one more cycle like this before I was able to sleep through the night.
I’ve woke up today with mild flu like symptoms and seem to be over with the worst of it.
Im not writing this to scare anyone who’s got their starter dose coming up but to just put it out there that pain killers will help if you get these feelings.
I didn’t get any swelling or localised pain in the injection site it was all just the fever.
Having woken up today and seen everyone’s replies here has really cheered me up so thanks to everyone and I’ll get back to you all when I feel more normal.
TLDR: Fever sucks and body aches are hell. It does subside though, take the pain meds!

I met with a new pain specialist after feeling stagnant with my previous one. The new pain specialist has prescribed me Ketamine 3 x a day on top of my current daily meds (tapentadol (slow & instant release), endep, codeine, paroxetine & clonidine. She wants me to eventually do an in-hospital ketamine infusion for 5 days (plus a nerve block injection), but to try the tablets first.
I’m due to pick up the medication tomorrow and I’m so nervous. I’ve never tried it before and don’t know what to expect.
Has anyone else been prescribed ketamine for pain management? would really love to hear your experiences & tips if you feel comfortable sharing 💛
for background: i have stage 4 endo and my pain is very severe & debilitating daily. I’ve had 3 x surgeries since 2022, including 2 excisions & an emergency hysterectomy. I also have a lot of issues with adhesions/scar tissue & cysts.

Race information

• What? RBC Brooklyn Half
• When? May 18, 2024
• How far? 13.1 miles
• Where? New York, NY
• Website: https://www.nyrr.org/races/2024rbcbrooklynhalf
• Finish time: 1:40:XX

Goals

Goal	Description	Completed?
A	Sub 1:38	No
B	Sub 1:40	No
C	As far sub 2:00 as possible	Yes
D	Run really fast	Yes

Background

I was an athlete, but never a runner. Growing up I played baseball and soccer, then lacrosse and football. Running was something done in laps, and it was a punishment. I went on one run as a teenager, but it was with a girl I thought was cute, and I could barely keep up with her. Then, at 17, I tore my ACL. At 18 I had two surgeries for post-op infections from the ACL surgery. At 19, another surgery to remove one of the original screws from the ACL. At 20, I tore my meniscus and had a partial meniscectomy.
A few years later, I started running a little. Nothing regular, or structured. Then I made friends with a triathlete and was inspired to sign up for some races. I hated the swim, liked the bike, tolerated the run. I don’t think I ever ran more than 6.2 miles for the entirety of my 20s.
By 30, I couldn’t run. Osteoarthritis had kicked in hard and athletic stuff was too painful to enjoy. By 32 I was talking to orthopedic surgeons about a knee replacement. Injections didn’t work, and PT was prehab. Daily life was too much. I couldn’t sleep through the night, I was icing my knee at my desk during the day, stairs were a thing to be avoided if possible and navigated carefully if required - the whole bit. Keeping up with two toddlers was impossible.
A medium-sized miracle happened. I was accepted into a clinical trial, the “Atlas Study” for a new surgically implanted device that offloaded the medial side of the knee. I was nearly the last of 50 patients in this study - and definitely one of the youngest. Atlas was successful, and another trial followed, and then FDA approval just before the six years anniversary of my surgery. The device is now known as the MISHA Knee System.

Training

I ran somewhat irregularly, 8-10 miles in a good week, post-COVID. We got a treadmill in 2020 because my wife used to go the gym solely to run. So I made use of it, and never ran outside, 2020-April 2024.
I got it in my head to run a half marathon around the holidays. I was feeling good, and wanted a new goal. I started climbing again in September 2023, and wanted another, complementary challenge - something more concrete. I started my training the second week of January. I had no idea what I was doing. I just hoped I could train successfully, and without triggering knee pain.
I looked at the Hal Higdon Novice 1, and tweaked to my purposes - 3 days a week of running, three days of climbing, and some kickboxing classes thrown in for good measure. Plus a two week ski trip at serious altitude in late March - I’ll come back to this. So: Monday and Wednesdays were shorter runs, Saturdays were long runs. Tuesday, Thursday, and Sunday were climbing days at my local gym. Plus a goal of a weekday kickboxing class and a weekend kickboxing class, which meant some days were a double. It was a big jump in training volume.
Monday and Wednesday runs started out at 3 miles and built up in half mile increments to 5, according to Hal’s plan. Dearest Hal says next to nothing about pace, so like an enthusiastic but naive child I just ran as close to my goal pace as possible, over the distance specified, hoping to get the treadmill to an average of 6.6. I basically negative split my runs at threshold out of the gates. And Saturday runs? The same thing. Trying to get to 6.6 on that treadmill. From no consistent base.
Then at the end of January I tore my TFCC - plus two other ligaments in my wrist. No climbing for 8 weeks, no kickboxing for at least that long. Cross training plans are out for a while.
Nothing but running to keep me sane, for a bit. Stuck with three days a week. I skipped racing the 5k and 10k in the plan and just advanced the long run to the next mile. But that ski trip hit, right after I ran 10 miles for the first time. Two weeks with a ton of cross training, and almost zero running - I tried one run, but at ~9000 feet instead of home at ~20, I died after about 2 miles.
Post trip, I had six weeks to race day. Climbing was back in as cross training. Shorter runs were all 5 miles, Saturday runs were 9, 10, 13.1, 10, 3, race day. I started reading Reddit voraciously and my TikTok feed started giving me running coaches and I discovered this wild idea called “zone 2 running” - wow was it easier! So weird. For the first time I did some intervals, some threshold work, a 10 mile progression run, and actual easy runs. It was in early April when I realized my original goal - break 2 hours - was the wrong time altogether. That 13.1 mile run was my second run off a treadmill. I had downloaded Strava but didn’t know it could tell me my times in my headphones. I just went out for an 11 mile run, felt good, extended it, and found out afterwards that I ran a 1:42:XX. I was shocked, my treadmill pace had never been that fast. And I was trying hard, but maybe not as hard as possible. I set new goals.
The next weekend I did a 10 mile progression run outside, with Strava telling me times. I had basically no time to learn what different paces felt like, so I negative split 10 miles and tried to remember what felt good, and what felt like too much.
Before you know it, it was time to taper. Another new experience for me. One climbing session, no kickboxing, 3 mile runs.

Race Day

I drove myself nuts trying to decide whether to run in my assigned corral, 1L, or drop back to 2A. Passing thousands of people or open roads? I’ll never know if I made the right call.
Slept horribly. Maybe 3.5 hours. Multiple wakeups and I was up for good at 4:10. I tried to use everything I learned about nutrition in the days leading up to the race - I was so hydrated, and had so. many. carbs. I had a very upset stomach on race morning and went light with food, had some Imodium, and focused on trying to follow the routine I laid out.
Commute was fine, getting checked in was fine, adrenaline was starting to kick in. Positioned myself at the front of L, and suddenly realized how many people were out there. It felt like forever to start moving, and then the slow walk… and around the corner, which I didn’t expect, and I started Strava early. And we’re off!
Within a minute it’s obvious that I am not going to be able to set my own pace against the prevailing tide of humanity. Maybe half a mile in I see a few people using the sidewalk on the right - nah, I think, then about 15 seconds later I’m blocked ahead and to my left and so say fuck it and go. Good decision.
My focus on the first 5k was not to go out too fast, but not to get bogged down in traffic. 7:58 mile average per NYRR. Mission accomplished.
My focus in the second 5k was to control the hills, but not burn out. And not create a big time deficit. And not get bogged down in traffic. 8:00 per mile average. Mission very accomplished.
10-15k, I wanted to open it up a bit. Not full throttle, I was worried about leaving something in the tank. And not getting bogged down in traffic. It was spacing out a bit more, but I was still running on the left side for clearer roads most of the time, and working right to get to the water stations. 7:27 average. Mission accomplished, and feeling good
Now we’re between mile 9 and 10. I take my third gel just before the aid station, and start to think about how fast I can go. Mile 10 of that progression run in training was 6:47. That’s the goal now. In retrospect - it was also with a vest, uncrowded Central Park roads, no slowing for aid stations. Repeat after me: you should not be upset with actual results. Mile 11-12 sucked. It was probably the only time I didn’t negative split. But: 15k to 20k - 7:21
Home stretch - I did not pay enough attention to the map; to Reddit, to NYRR’s descriptions. The big right on Surf Road? A surprise. Started my kick. The ramp to the Boardwalk? I guess it was new, but man did it feel terrible. Second attempt at a kick. Do not get bogged down. Smile! We’re through. 7:02 pace.

Post-race

Would I have run faster in Wave 2? We’ll never know, and hopefully never find out. Passing thousands of people because I guessed wrong about my time was weird. I used a lot of energy and ran a fair bit of extra distance because of it. 17 seconds to beat 1:40? Maybe. Or maybe I needed to pass people for motivation.
But more than anything, as I reflect, I am grateful. I’m grateful to be able to run at all, because I know what it’s like to struggle to walk.I am grateful for my doctor that referrred me to the study, to my surgeon, Dr Andreas Gomoll, to all the people behind the MISHA device. I’m grateful to Abby Bales, my PT for prehab and rehab from surgery, and everyone who has been a part of my crazy orthopedic history.
I caught the running bug. I’ll be back. Sub 1:35 feels like the next step. I’ve only just begun, and I achieved my biggest goal - run happy. I have the race photos to prove it.
This post was generated using the new race-reportr, powered by coachview, for making organized, easy-to-read, and beautiful race reports.

TL;DR— Nasacort and Singulair have changed my life for the better. Thanks to this thread for those recommendations!
I just wanted to share here (since this thread has been so helpful to me) that I’ve recently found significant relief in starting two new meds— one being Nasacort, a simple OTC spray, the other being Singulair (Montelukast), a Rx drug that I was hesitant to take for years due to its Black label warning from the FDA, but which has helped me tremendously.
Y’all shared in these threads that these medications had changed your life, and I’m so grateful because that gave me the push I needed to try them. I’ve always had pretty bad seasonal allergies, but after having COVID in 2022, my allergies went completely crazy. April through September were a nightmare. I could barely function, had terrible brain fog, debilitating symptoms, had trouble working, couldn’t go outside, began experiencing allergic asthma… the whole works. Hay fever all day every day. I had sinus infections that led to terrible bronchitis. I was living on multiple Zyrtec a day (which honestly didn’t touch my symptoms), Sudafed during the day, Benadryl at night, Flonase, Ipaproprium Bromide spray and a host of supplements (Quercetin, vitamin c, stinging nettle, et.al) I tried EVERYTHING. (And I mean everything— diet, breath work, acupuncture, Ayurvedic treatments, the lot.) The majority of “alternative” / natural remedies have helped a little, but they’re more an extra support for my symptoms… they really didn’t do a whole lot for me.
Someone on here recommended Nasacort. And while it took a few weeks to kick in, when it did, a TOTAL game changer. I am free of chronic postnasal drip for maybe the first time in years?! I cannot believe it. If you haven’t tried Nasacort yet, I highly recommend it. No negative side effects. Safe for longer term use.
Upon searching these threads for how to deal with allergic asthma, I read more about Singulair. I’d always been nervous to take it because it can have bad psychological side effects, but it was nearly my last resort. My allergist told me that some folks have bad side effects, but the majority of people tolerate it well. I’m thrilled to say it’s working SO well for me. (Full disclosure: I also take Wellbutrin, an antidepressant). Singulair makes you a little sleepy, so it’s recommended you take it at night. It can give you very vivid dreams, and in my case, that’s been true. Other than that, zero side effects. My dreams are weirdly way more fun now, lol. Singulair has eliminated my allergic asthma— I can now exercise outside now during allergy season and not have to spend the next day in bed. Hallelujah!
Anyways, as a lifelong allergy sufferer / long Covid allergy mystery, I just wanted to share that these meds have helped me tremendously and I hope everyone can get what they need this allergy season!
Extra disclosure— I am very early in this journey, so no way to tell yet how much it’s helping, but I’m doing allergy immunotherapy with my allergist. I started with shots, but started reacting with major swelling at a very low dosage of the subcutaneous injection, so he has switched me to SLIT— sublingual drops. They’re European dosing guidelines, so very high quality and a high concentration serum. I’m only one month in, so I can’t say decisively how much they’re helping yet because it’s a 5 year process, but I’m hopeful my full court press against my seasonal allergies does the trick.

I want to start this post by saying I am not specifically asking for medical advice. If anything this is more of a vent at this point. Also, there is small talk about medical things so keep that in mind before you read.
So I've been struggling with chronic atopic dermatitis my whole life. Unfortunately my condition is a genetic factor meaning this shit won't go away. I've tried every medicine available and I'm on the dupixant train rn. I've used dupxiant coming up on a year now and it's worked great for a while. Almost completely clear skin but lately my skin has started to have adverse reactions to the shot. My dermatologist told me I'm 1% of people who experience those affects and I'm just so tired.
Research wants me to do a medical trial for a new medication, it hasn't been FDA approved yet and is still in the testing phase. It's an injectable which isn't the issue for me.. but with the injectable I have to get 7 vials of blood drawn every two weeks. I'm scared.. I've never had my blood drawn let alone that much blood. The nice thing is if this medication works, it's covered for free until 2028, I also get 100$ every two weeks for participating in the trial..
I don't know what to do... I wish I could just press a magic button and this chronic illness could go poof. I'm tired of it. :(

The global ophthalmic ultrasound devices market is expected to achieve a notable Compound Annual Growth Rate (CAGR) of approximately 8% by 2030. This growth is primarily propelled by the escalating incidence of eye-related disorders like cataracts and diabetic retinopathy. Notably, according to the World Health Organization (WHO), approximately 1 billion individuals are affected by vision impairment or blindness attributed to diverse eye diseases, with refractive error, cataracts, and glaucoma constituting significant proportions.
To know more about this study, request a free sample report @ https://www.researchcorridor.com/request-sample/?id=65095
Market Trends:
Advancements in Imaging Technologies: Ongoing advancements in imaging technologies, such as high-resolution ultrasound and optical coherence tomography (OCT), are enhancing the diagnostic capabilities of ophthalmic ultrasound devices. These technologies enable detailed visualization of ocular structures, facilitating accurate diagnosis and treatment planning for various eye conditions.
Rise in Minimally Invasive Procedures: There is a growing trend towards minimally invasive procedures in ophthalmology, driven by patient preference for faster recovery times and reduced risks. Ophthalmic ultrasound devices play a crucial role in guiding minimally invasive surgeries such as cataract extraction, vitrectomy, and intraocular injections, contributing to the market's growth.
Increasing Incidence of Age-Related Eye Diseases: The aging population worldwide is contributing to the rising prevalence of age-related eye diseases such as cataracts, macular degeneration, and glaucoma. Ophthalmic ultrasound devices are essential tools for diagnosing and monitoring these conditions, driving their demand in the market.
Focus on Point-of-Care Ultrasound: There is a growing emphasis on point-of-care ultrasound (POCUS) in ophthalmology clinics and emergency departments. Portable and handheld ophthalmic ultrasound devices enable quick and convenient assessment of ocular conditions at the bedside, improving patient care and clinical workflow efficiency.
Integration of Artificial Intelligence (AI): The integration of artificial intelligence (AI) algorithms into ophthalmic ultrasound devices is enhancing their diagnostic accuracy and efficiency. AI-powered software assists in automated image interpretation, enabling faster diagnosis of eye conditions and facilitating personalized treatment plans.
Market Opportunities:
The ophthalmic ultrasound devices market presents significant opportunities driven by several key factors. Firstly, the increasing prevalence of age-related eye diseases, such as cataracts and macular degeneration, underscores the need for advanced diagnostic tools like ophthalmic ultrasound devices. Additionally, the growing adoption of minimally invasive ophthalmic procedures and the rise of point-of-care ultrasound in ophthalmology clinics create demand for portable and handheld ultrasound devices that offer convenience and efficiency. Moreover, the integration of artificial intelligence (AI) algorithms into ultrasound systems enhances diagnostic accuracy and enables personalized treatment approaches, positioning AI-powered ophthalmic ultrasound devices as a valuable asset in clinical practice.
According to the recent report published by RC Market Analytics, the Global Ophthalmic Ultrasound Devices Market is expected to provide sustainable growth opportunities during the forecast period from 2024 to 2030. This latest industry research study analyzes the ophthalmic ultrasound devices market by various product segments, applications, regions and countries while assessing regional performances of numerous leading market participants. The report offers a holistic view of the ophthalmic ultrasound devices industry encompassing numerous stakeholders including raw material suppliers, providers, distributors, consumers and government agencies, among others. Furthermore, the report includes detailed quantitative and qualitative analysis of the global market considering market history, product development, regional dynamics, competitive landscape, and key success factors (KSFs) in the industry.
Browse the Full Report Discretion @ https://www.researchcorridor.com/ophthalmic-ultrasound-devices-market/
Geographically, the ophthalmic ultrasound devices market report comprises dedicated sections centering on the regional market revenue and trends. The ophthalmic ultrasound devices market has been segmented on the basis of geographic regions into North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa. Ophthalmic ultrasound devices market estimates have also been provided for the historical years 2020 to 2023 along with forecast for the period from 2024 - 2030.The report includes a deep-dive analysis of key countries including the U.S., Canada, the U.K., Germany, France, Italy, China, Japan, India, Australia, Mexico, Brazil and South Africa, among others. Thereby, the report identifies unique growth opportunities across the world based on trends occurring in various developed and developing economies.
The Ophthalmic Ultrasound Devices Market Segmentation:
By Product:

• A-Scan
• B-Scan
• Combined Scan
• Pachymeter
• Ultrasound Bio-microscopy (UBM)

By Modality:

• Portable
• Standalone

By End-User:

• Hospitals
• Ophthalmology Clinics
• Others

By Region:

• North America
• Europe
• Asia Pacific
• Latin America
• Middle East & Africa

Key players in the global ophthalmic ultrasound devices market include Appasamy Associates, DGH Technology, Ellex, Quantel Medical, and Optos Plc. These companies employ various strategies such as market expansion, new investments, service innovations, and strategic collaborations to explore new opportunities. For instance, in March 2019, Quantel Medical received FDA approval for the launch of its product called ABSolu, demonstrating a commitment to product innovation. Additionally, players in this market are exploring new geographical territories through expansion and acquisition, aiming to leverage joint synergies and gain a competitive edge.
To know more about this study, request a free sample report @ https://www.researchcorridor.com/request-sample/?id=65095
Key Questions Answered by Ophthalmic Ultrasound Devices Market Report:

• Product popularity and adoption based on various country-level dynamics
• Regional presence and product development for leading market participants
• Market forecasts and trend analysis based on ongoing investments and economic growth in key countries
• Competitive landscape based on revenue, product offerings, years of presence, number of employees and market concentration, among others
• Various industry models such as SWOT analysis, Pestle Analysis, Porter’s Five Force model, Value Chain Analysis pertaining to Ophthalmic Ultrasound Devices market
• Analysis of the key factors driving and restraining the growth of the global, regional and country-level markets from 2020-2030

About Us:RC Market Analytics is a global market research firm. Our insightful analysis is focused on developed and emerging markets. We identify trends and forecast markets with a view to aid businesses identify market opportunities to optimize strategies. Our expert’s team of analysts’ provides enterprises with strategic insights. RC Market Analytics works to help enterprises grow through strategic insights and actionable solutions. Feel free to contact us for any report customization at sales@researchcorridor.com.
Media Contact:
Company Name: RC Market Analytics Pvt. Ltd. Contact Person: Vijendra Singh Email: sales@researchcorridor.com Visit us: https://www.researchcorridor.com/

~RIGL Thesis – 5/18/2024~
Outstanding Shares 175M
131 Institutional Holders
111,129,461 Total Shares Held
63.36% Institutional Ownership
Total Cash on Hand 3/31/2024 = $49.6M
Total Debt: $101.5M
Cash Burn Approximate = $8M per quarter (6 quarters of cash without any increases in revenue)
Q12023 REV = $26M
Q22023 REV = $26.8M
Q32023 REV = $28.1M
Q42023 REV = $35.8M
Q12024 REV = $29.5M (Decline from Q4 likely from end of year versus new-year tracking of Rx and shipments of drugs, resetting of Copays)
Most Recent EPS -$0.05 per share
May 22, 2024 - Vote on S will take place, caution
~Statistics Applicable To Thesis~
333.3 million US Population (2022)
8,109,679,892 Global Population (2024)
~Drugs On Market~
~Tavalisse – Treatment for ITP, FDA Approved April 17, 2018~
~What is ITP?~
Immune thrombocytopenia (ITP) is an illness that can lead to bruising and bleeding. Low levels of the cells that help blood clot, also known as platelets, most often cause the bleeding.
Once known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises. It also can cause tiny reddish-purple dots on the skin that look like a rash.
Children can get ITP after a virus. They most often get better without treatment. In adults, the illness often lasts months or years. People with ITP who aren't bleeding and whose platelet count isn't too low might not need treatment. For worse symptoms, treatment might include medicines to raise platelet count or surgery to remove the spleen. Immune thrombocytopenia (ITP) - Symptoms and causes - Mayo Clinic
~What is Tavalisse?~
TAVALISSE is a prescription medication used to treat adults with low platelet counts due to chronic immune thrombocytopenia (ITP) when a prior treatment for ITP has not worked well enough. It is not known if TAVALISSE is safe and effective in children.
The cost for Tavalisse oral tablet 100 mg is around $15,404 for a supply of 60 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Tavalisse Prices, Coupons, Copay & Patient Assistance - Drugs.com
TAVALISSE IS AN ORAL MEDICATION TAKEN TWICE DAILY WITH OR WITHOUT FOOD¹
A 12-week evaluation period is recommended
60 tablets = 1 month supply, evaluation period = 3 months, Cost for 3 months = $46,212 Cash, assuming cheaper through wholesale, insurance, discount cards, etc.
Dosing TAVALISSE® (fostamatinib disodium hexahydrate) tablets (tavalissehcp.com)
~Addressable Market~
“Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.”
Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis - PubMed (nih.gov)
The estimated prevalence of ITP in the United States is 9.5 per 100,000 people, with a global prevalence of over 200,000 people at any given time [1].
Immune thrombocytopenia. [ Oct; 2022 ]. 2022. https://rarediseases.org/rare-diseases/immune-thrombocytopenia
~Author Calculations/Estimates~
ITP estimated cases based on measured statistics 31,635 cases a year in the US and 770,355 cases globally each year.
~Rezlidhia – R Acute Myeloid Leukemia, FDA Approved December, 22, 2022~
~What is Relapsed or Refractory Acute Myeloid Leukemia?~
Relapsed, or recurrent, acute myeloid leukemia (AML) means the leukemia has come back after treatment and remission.
Refractory AML means the leukemia did not respond to treatment. Complete remission has not been reached because the chemotherapy drugs did not kill enough leukemia cells.
Both relapsed and refractory AML need more treatment to reach complete remission.
Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Some factors considered for your treatment include:
your age
your health
how long the leukemia was in remission
treatments you had before
where the leukemia comes back
Treatment options usually include chemotherapy and a stem cell transplant if possible. Targeted therapy may also be used.
Treatments for relapsed or refractory acute myeloid leukemia Canadian Cancer Society
~What is IDH1?~
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult Acute myeloid leukemia (AML) and less commonly in pediatric AML… Enhanced genomic and epigenomic profiling of acute myeloid leukemia (AML) has led to identification of recurrent mutations that are prognostic and are candidates for targeted therapy. Somatic mutations in isocitrate dehydrogenase (IDH) genes, IDH1 and IDH2, occur in ∼6% to 16% and ∼8% to 19% of adult patients with AML, respectively.^1-5 In pediatric AML, IDH mutations are rare, occurring in <4% of patients.^6-11
Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis Blood Advances American Society of Hematology (ashpublications.org)
~What is Rezlidhia?~
REZLIDHIA is a prescription medicine used to treat adults with acute myeloid leukemia (AML) with an isocitrate dehydrogenase-1 (IDH1) mutation when the disease has come back or has not improved after previous treatment(s).
Targeted Treatment REZLIDHIA® (olutasidenib) capsules
The cost for Rezlidhia oral capsule 150 mg is around $17,468 for a supply of 30 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Rezlidhia Prices, Coupons, Copay & Patient Assistance - Drugs.com%20is%20a%20member,on%20the%20pharmacy%20you%20visit.)
~Addressable Market~
The annual incidence of new cases in both men and women is approximately 4.3 per 100,000 population, totaling over 20,000 cases per year in the United States alone.[13] The median age at the time of diagnosis is about 68, with a higher prevalence observed among non-Hispanic Whites. Furthermore, males exhibit a higher incidence compared to females, with a ratio of 5:3.
Acute Myeloid Leukemia - StatPearls - NCBI Bookshelf (nih.gov)
~Author Calculations/Estimates~
Cases of AML with IDH1 would be 11% based on the median of statistics above (6% to 16%) leaving approximately 1500 to 2000 cases a year in the US. Appling the same calculations to world population would amount to approximately 38,500 cases a year globally.
~Gavreto – Treats RET+ Non-Small Cell Lung Cancer In Adults and RET+ Thyroid Cancer in Kids and Adults, FDA Approved August 9, 2023~
For the sake of common ground, I am going to assume these types of cancers do not need to be elaborated on as we all likely have a basic understanding of what they are. The medical conditions treated by Tavalisse and Rezlidhia I felt needed a more in-depth explanation because they are not common. I will elaborate on RET+ a little later in this writing.
~What is Gavreto?~
GAVRETO is an oral once daily prescription medicine used to treat certain cancers caused by abnormal rearranged during transfection ~(RET+)~ genes in:
Adults with non-small cell lung cancer (NSCLC) that has spread
Adults and children 12 years of age and older with advanced thyroid cancer or thyroid cancer that has spread who require a medicine by mouth or injection (systemic therapy) and who have received radioactive iodine and it did not work or is no longer working*
It is not known if GAVRETO is safe and effective when used to treat cancers caused by abnormal RET genes in children for the treatment of NSCLC or in children younger than 12 years of age for the treatment of thyroid cancer.
Home GAVRETO® (pralsetinib)
The cost for Gavreto oral capsule 100 mg is around $11,745 for a supply of 60 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
The recommended dosage for adults and children 12 and over is 400mg orally once daily. Each capsule is 100mg, which means you will take 4 capsules. Gavreto should be taken on an empty stomach, at least 1 hour before or 2 hours after a meal.
Gavreto Prices, Coupons, Copay & Patient Assistance - Drugs.com
~What is Rearranged During Transfection Positive (RET+)?~
RET-positive cancer is caused by a mutation or abnormal re-arrangement of the RET gene. It occurs most commonly in lung cancer and several types of inherited and sporadic thyroid cancers. RET alterations also occur in an estimated 1-2% of multiple other cancers, including ovarian, pancreatic, salivary, breast, and colorectal cancers.
RETpositive Empowering Patients and Driving Research
Rearranged during transfection (RET) rearrangements were first identified as oncogenic drivers in NSCLC in 2012. The proportion of patients with NSCLC who have RET rearrangements (ie, fusion-positive disease) is approximately 1%-2%.
RET Fusion-Positive Non-small Cell Lung Cancer: The Evolving Treatment Landscape The Oncologist Oxford Academic (oup.com)
RET alterations occur most commonly in lung cancer (non-small cell lung cancer (NSCLC)) and the number of new cases diagnosed each year is considerable, accounting for approximately 37,500 [IG1] cases worldwide and 4,000 cases in the US (2% of NSCLC) (2,3). RET alterations are also common in several types of inherited and sporadic thyroid cancers and can occur in other types of cancers like ovarian, breast, pancreatic, and colorectal cancers, among others (4-8) adding >110,000 cases yearly worldwide (9).
What is RET Positive Lung Cancer? - The Happy Lungs Project
(2) Although medullary thyroid carcinoma represents 5-10% of all thyroid cancers, activating RET gene abnormalities occur in over 90% of hereditary and approximately 40%-60% of sporadic medullary thyroid carcinoma cases.
Patients – RETpositive%20Although%20medullary%20thyroid%20carcinoma,sporadic%20medullary%20thyroid%20carcinoma%20cases.)
~Prevalence of Non-Small Cell Lung Cancer~
Most lung cancer statistics include both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). In general, about 10% to 15% of all lung cancers are SCLC, and about 80% to 85% are NSCLC.
Lung cancer (both small cell and non-small cell) is the second most common cancer in both men and women in the United States (not counting skin cancer). In men, prostate cancer is more common, while breast cancer is more common in women.
The American Cancer Society’s estimates for lung cancer in the US for 2024 are:
About 234,580 new cases of lung cancer (116,310 in men and 118,270 in women)
About 125,070 deaths from lung cancer (65,790 in men and 59,280 in women)
Lung Cancer Statistics How Common is Lung Cancer? American Cancer Society
Worldwide, an estimated 2,206,771 people were diagnosed with lung cancer in 2020. These statistics include both small cell lung cancer and NSCLC.
Lung Cancer - Non-Small Cell: Statistics Cancer.Net
~Author Calculations/Estimates~
Approximately 187,664 cases of NSCLC in the US based on an 80% factor.
Approximately 1,765,416 cases of NSCLC worldwide based on an 80% factor.
~Prevalence of Thyroid Cancer~
Rate of New Cases and Deaths per 100,000: The rate of new cases of thyroid cancer was 13.5 per 100,000 men and women per year. The death rate was 0.5 per 100,000 men and women per year. These rates are age-adjusted and based on 2017–2021 cases and 2018–2022 deaths.
Lifetime Risk of Developing Cancer: Approximately 1.2 percent of men and women will be diagnosed with thyroid cancer at some point during their lifetime, based on 2017–2019 data. Lifetime risk based on data through 2022 will available soon.
Prevalence of This Cancer: In 2021, there were an estimated 979,295 people living with thyroid cancer in the United States.
Thyroid Cancer — Cancer Stat Facts
About 44,020 new cases of thyroid cancer (12,500 in men and 31,520 in women)
About 2,170 deaths from thyroid cancer (990 in men and 1,180 in women)
Thyroid cancer is often diagnosed at a younger age than most other adult cancers. The average age when a person is diagnosed with thyroid cancer is 51.
This cancer is about 3 times more common in women than in men. It is about 40% to 50% less common in Black people than in any other racial or ethnic group.
Key Statistics for Thyroid Cancer American Cancer Society)
Addressable Market
Given Gavreto’s dual treatment capacity, the total amount of potential patients with NSCLC with RET+ indications would be approximately 2,800 cases in the US and approximately 26,500 cases worldwide each year using a factor of 1.5% of total NSCLC cases. The total amount of treatable cases for Thyroid Cancer would be approximately 650 in the US and 16,500 cases worldwide respectively each year applying the same 1.5% RET+ percentage rate. DOUBLE CHECK MATH…
~Rigel Pharmaceuticals Pipeline~
~IRAK/4 – Clinical Trials~
Rigel’s investigational candidate, R289, is an oral, potent and selective inhibitor of interleukin receptor-associated kinases 1 and 4 (IRAK1/4).
Toll like receptors (TLRs) and the interleukin 1 receptor family (IL-1Rs) play a critical role in the innate immune response and dysregulation of these pathways can lead to a variety of inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease. Chronic stimulation of both receptor systems has also been implicated in causing a pro-inflammatory bone marrow environment leading to persistent cytopenias in lower-risk myelodysplastic syndrome (LR-MDS) patients1.
R835 is a selective dual inhibitor of IRAK1/4 that blocks TLR4 and IL-1R-dependent systemic cytokine release. In preclinical studies, R835 demonstrated activity in multiple animal models of inflammatory disease2,3 and showed that dual inhibition of IRAK1 and IRAK4 provided more complete suppression of inflammatory cytokines when compared to an IRAK4-selective inhibitor4.
Development of R289:
In a Phase 1 clinical trial, R835 was well tolerated and inhibited LPS-induced inflammatory cytokine production in healthy volunteers, demonstrating proof-of-mechanism.5 Phase 1 clinical studies of R289 (an oral prodrug that is rapidly converted to R835 in the gut) are also complete.
A Phase 1b open-label, multicenter trial of R289 in patients with relapsed/refractory lower-risk MDS is currently enrolling (NCT05308264). The primary endpoint for this trial is safety with key secondary endpoints including preliminary efficacy and evaluation of pharmacokinetic properties.
~Bemcentinib – Bergenbio Partnership~
In June 2011, Rigel entered into an exclusive, worldwide research, development and commercialization agreement with BerGenBio for its investigational AXL receptor tyrosine kinase (AXL) inhibitor, R428 (now referred to as bemcentinib).
Bemcentinib is a potent, selective and orally bioavailable AXL inhibitor and the furthest along in clinical trials. In preclinical studies, bemcentinib was shown to have an effect as a single agent therapeutic in the prevention and reversal of acquired resistance to standard of care cytotoxics and targeted therapies and may also slow or prevent tumor metastasis.
Rigel received an upfront payment and is eligible for milestone payments and potential sublicensing revenue, as well as tiered royalty payments on any future net sales of products emerging from the collaboration.
~R552 Systemic – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies.
~Milademetan – Daiichi Sankyo Partnership~
Rigel has a long-standing collaboration with Daiichi-Sankyo for developing murine double minute 2 (MDM2) protein inhibitors in cancer, which were discovered in Rigel’s laboratories.
Preliminary safety and efficacy data from an early Phase 1 study of milademetan (formerly DS-3032), an oral selective MDM2 inhibitor, in hematological malignancies suggests that it may be a promising potential treatment for oncology indications.
Rigel received an upfront payment and is eligible for milestone payments, as well as tiered royalty payments on any future net sales of any products emerging from the collaboration.
~Rxxx (CNS Penetrant) – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies. Pipeline :: Rigel Pharmaceuticals, Inc. (RIGL)
~Summary and Prediction~
The current share price of sub $1 does not feel justified. I would anticipate financial breakeven by the end of 2024 or potentially in Q1 or Q2 of 2025. The robust pipeline, progress, and expected revenue growth are enough to justify a much higher valuation. The debt load is manageable, but the potential for S is concerning. I believe that the S is not necessary and revenue growth and progress should speak for itself. I am not as bullish as the analysts at HC Wainright for a $15 PT, but the valuation should be at least 3x to 5x from the current value. This thesis does not highlight the patents surrounding their drugs either which some extend into 2035 and beyond. Perhaps what Wall Street is discounting is the fact that most of the drugs are very niche. However, the currently available drugs have an addressable market, albeit less universal than some, but you should value it in the sense of multiple facets (a 1000 headed snake is the phrase I wanted to use). I believe the company should be valued with specialty drugs in mind which would command a higher PE ratio. At the current day and time of writing, the value should be at least $1.50 to $1.75 ~at a minimum~ with a 12 month price target of $3 to $5+. I will be looking for continued revenue growth in each quarter this year and realization of revenue from Gavreto in Q2 or Q3 this year. The partnerships should not be discounted either and the current share price if it lingers here perhaps may attract a merger or acquisition. I initially began the research thinking that perhaps the drugs were too niche, but given the multiple drugs they are working with, I believe their revenue sources will continue to grow if you do not focus on one particular drug as the main performer. With the most recent inflation report being cooler than expected, I would suspect larger funds and institutions will be circling back to riskier assets.

Over a year ago I had been on Mounjaro for 9 months, I went from 420 lbs to 350 lbs and let me tell you… it was life changing. I could no longer pay out of pocket for it since insurance wouldn’t cover it. After 5 months of fighting with my insurance to try and have them cover the medication that was clearly working… Mounjaro was approved by the FDA and rebranded as ZepBound. I thought for sure my insurance would then allow it. Then November 2023 I started a new fight with my insurance to try and get on ZepBound. Unfortunately; I fought with my insurance for another 5 and a half months and after having a 20 lb backslide, just as I was giving up, I tried one last Hail Mary by getting a prescription of Orlistat which was one of the other “preferred medications” that none of my doctors wanted me on but my insurance insisted that I try. Did that for a week and my doc contacted insurance and pled my case one last time, I finally got the approval to be on ZepBound.
In preparation to be on the medication, last week, I focused solely on a protein forward diet with little to no carbs to try and keep side effects to a minimum after my (second) Day 1 of taking this injectible medication. Just like last time, I select my inject day to be Friday which gives me the weekend to handle whatever side effects I may experience.
Weighing myself yesterday, I am at 360.8 lbs and here I start again. The evening of the first day, I started to get the gassy-ness of the burps and fortunately I had my gas-ex and papaya extract tablets handy. But this afternoon, I’m feeling a little like I got body slammed. I don’t remember this feeling the first time around but I’m actually wondering if it’s a lack of hydration that is causing this muscle ache.
Either way… those of you on the journey as well… may it be one with success and few side effects. See you in the threads.

Just an update from an earlier post, in case it helps someone else. These are the experiences I have had. I'm not suggesting anyone generalize from them. I still don't know why I was deficient, nor are all my symptoms gone. The onset of my worst symptoms (tingling, numbness, walking difficulty) was mid January 2024, so this is about five months. But I am 90% better now.
Supplementing: 5000 mcg B12 methylcobalamin sublingual daily (2500 twice daily); 8 mg copper daily (will then taper weekly to 6, 4, and 2 for maintenance).

1. Mental Health. I was having intense anxiety along with neurological and gastric issues. I blocked Reddit and stopped doing most health info searches for a while as I took B12. The only thing I let myself do was an occasional look through peer-reviewed material (PubMed, Google Scholar, etc.) I would bookmark it, take notes, and note questions. This was very helpful, mentally.
2. Advocacy. When my neurological symptoms didn't get better after just a few, once-weekly injections, I came back to my nurse practitioner with two articles. I laid out the timeline, the symptoms, my response to the injections, and asked her what the next steps should be, since I was concerned about permanent neurological damage. She agreed to do two injections per week for two weeks. The two articles I shared:
   • Vitamin B12, BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2022-071725 (Published 20 November 2023) https://www.bmj.com/content/383/bmj-2022-071725
   • The Many Faces of Cobalamin (Vitamin B12) Deficiency, Mayo Clin Proc Innov Qual Outcomes. 2019 Jun; 3(2): 200–214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543499/
3. Changing doctors. I then also did a telephone call with another provider, a doctor, who immediately said that we should consider copper if my muscle twitches and peripheral neuropathy weren't resolving. He also said that my rapid weight loss was troubling, and that we might consider a GI specialist referral.
   • The result is that we have identified a copper deficiency, which I am supplementing for. This also suggests that there is an underlying cause other than diet (my NP's original theory).
   • If I hadn't had the copper test, the NP would have just sent me to a neurologist, and that would involve several more months waiting.
   • Just a few days into supplementing copper and some symptoms are resolving: my palms and feet are not constantly burning. I still have some tingling, but it is less widespread. And my muscle twitches are diminishing.
   • The new doctor suggested I switch to methylcobalamin for bioavailability reasons. I am taking that as sublingual drops. He also prescribed me an injection kit, once-monthly of 1000 mcg.
4. Caution in "life-hacking" diet and supplements. The other hing that hurt/helped me so far involves trying to fix things quickly by diet or supplements. This is related to (1) and online searches. After experiencing some cramps, I became worried I had low electrolytes. I did not supplement potassium (my understanding is this should be done under doctor supervision). But I did start drinking a lot of coconut water and eating prunes. (I also had a bout of constipation.)
   • The coconut water and prunes caused diarrhea, but I didn't realize it (I was just going very frequently). This impacted my B12 absoprtion negatively for a while, and the sugar from the coconut water gave me more cramps.
   • I also made sure to check into the kinds of fish I should be eating to avoid a lot of mercury (I'm a pescatarian). I started to eat a lot of tuna but realized that albacore shouldn't be eaten more than once weekly (with no other fish). So I do skipjack only, plus salmon, sardines, etc.
5. Symptom journal. Finally, what helped me talk with the doctors more effectively was to keep a symptom journal in a small notebook. I noted sleep habits, weight, bowel movements, diet, nerve stuff, fatigue. Then I would transfer it weekly into a spreadsheet that I paired with blood test info.
   • This let me speak in concrete terms with the provider, focusing on symptoms. Starting here rather than with my own theories or desires for treatment (even if I was reading peer-reviewed material) helped a lot.
   • I also committed to telling them everything even if I thought it was irrelevant or worried it was just "in my head." My challenges in word-finding that I had many months ago is gone, and probably should have been mentioned much earlier. Etc.

Title: Understanding Fentanyl: Uses, Risks, and Controversies
Introduction: Fentanyl, a potent synthetic opioid, has gained significant attention in recent years due to its role in the opioid epidemic. This article aims to provide a comprehensive overview of fentanyl, including its medical uses, associated risks, and the controversies surrounding its widespread misuse.
Medical Uses: Originally developed for managing severe pain, especially in cancer patients, fentanyl is an analgesic that is 50 to 100 times more potent than morphine. It is commonly used in medical settings for pain management during surgeries, chronic pain conditions, and palliative care.
Risk Factors: While fentanyl is effective in controlling pain when administered under medical supervision, its misuse poses serious health risks. The drug's high potency increases the likelihood of overdose, leading to respiratory depression and, in extreme cases, death. Illicitly manufactured fentanyl, often mixed with other substances, has been a major contributor to the rising number of opioid-related deaths.
Controversies and Illicit Use: The illicit use of fentanyl has sparked controversy and public health concerns. The drug is often clandestinely produced and added to other drugs, such as heroin or cocaine, without the user's knowledge. This has resulted in a surge in overdoses, as individuals may unintentionally consume lethal doses of the opioid.
Law Enforcement and Regulation: Governments and law enforcement agencies worldwide are grappling with the challenges posed by the illicit production and distribution of fentanyl. Efforts to regulate its manufacturing and distribution are ongoing, with stricter controls in place to prevent diversion into illegal channels.
Treatment and Harm Reduction: Addressing the fentanyl crisis requires a multi-faceted approach, including expanded access to addiction treatment, harm reduction strategies, and public awareness campaigns. Naloxone, an opioid receptor antagonist, has proven effective in reversing opioid overdoses and is increasingly available to first responders and the general public.
Conclusion: Fentanyl, with its remarkable pain-relieving properties, has become a double-edged sword in the realm of healthcare. While it serves a crucial role in medical settings, its misuse poses severe risks to public health. Efforts to combat the opioid epidemic must focus on education, regulation, and treatment to strike a balance between managing pain effectively and preventing the tragic consequences of its illicit use.
Narcan, also known by its generic name naloxone, is a medication used to rapidly reverse opioid overdose. It works by binding to the same receptors in the brain that opioids target, effectively reversing the life-threatening effects of opioid toxicity. Narcan is commonly administered in emergency situations where an individual is experiencing respiratory depression or unconsciousness due to opioid overdose.
Emergency responders, healthcare professionals, and even some non-professionals, such as family members of individuals at risk of opioid overdose, may carry naloxone. The medication is available in various forms, including nasal sprays and injectable formulations, making it accessible for different situations.
The prompt administration of Narcan can restore normal breathing and consciousness, providing crucial time for the affected person to receive further medical attention. It is an essential tool in harm reduction strategies aimed at preventing opioid-related deaths and is a key component of public health initiatives addressing the opioid epidemic.
Suboxone is a prescription medication used in the treatment of opioid dependence and addiction. It is a combination of two active ingredients: buprenorphine and naloxone.

1. Buprenorphine: This is a partial opioid agonist, meaning it binds to the same receptors in the brain that opioids bind to but with less intensity. It helps to reduce cravings and withdrawal symptoms, allowing individuals in recovery to better manage their addiction.
   
2. Naloxone: Naloxone is an opioid receptor antagonist, which means it blocks the effects of opioids. When taken as directed, naloxone remains largely inactive. However, if someone were to misuse Suboxone by injecting it, the naloxone component can counteract the opioid effects, reducing the risk of misuse.
   

Suboxone is often prescribed as part of medication-assisted treatment (MAT), a comprehensive approach to opioid addiction that includes counseling, therapy, and support services. It can be used in the detoxification phase as well as for long-term maintenance therapy. The goal of Suboxone treatment is to help individuals gradually reduce their dependence on opioids, manage cravings, and improve their overall quality of life during recovery.
It's important to note that Suboxone should only be used under the supervision of a qualified healthcare professional, as improper use or abrupt discontinuation can lead to withdrawal symptoms or other complications.
Precipitated withdrawal refers to the accelerated onset of withdrawal symptoms, often more severe than typical, when an opioid antagonist is introduced to the body. This occurs because the antagonist displaces the opioid from receptors, leading to a sudden and intense withdrawal reaction.
For example, if someone is currently dependent on opioids and receives a medication like naloxone or naltrexone, which are opioid antagonists, it can rapidly trigger withdrawal symptoms. This is a safety mechanism, as these medications are often used to reverse opioid overdose or as part of addiction treatment.
The term is commonly associated with medication-assisted treatment for opioid use disorder, where medications like buprenorphine (a partial opioid agonist) are used. If buprenorphine is administered before other full opioids have cleared from the system, it can displace those opioids from receptors, leading to precipitated withdrawal. This is why healthcare providers carefully time the initiation of medications like buprenorphine to avoid this intensified withdrawal reaction.
Understanding the potential for precipitated withdrawal is crucial in the context of addiction treatment to ensure safe and effective transitions between medications and to minimize discomfort for individuals in recovery.
Using Suboxone involves adherence to a specific treatment plan under the guidance of a qualified healthcare professional. Here are some key aspects related to the use of Suboxone:

1. Prescription and Medical Supervision: Suboxone is a prescription medication, and its use should be initiated and supervised by a qualified healthcare provider, typically in the context of medication-assisted treatment (MAT) for opioid use disorder.
   
2. Dosage: The healthcare provider will determine the appropriate dosage based on the individual's specific needs and response to the medication. It's essential to follow the prescribed dosage and not adjust it without consulting the healthcare provider.
   
3. Administration: Suboxone is often administered sublingually, meaning it is placed under the tongue and allowed to dissolve. This method allows for the absorption of the medication into the bloodstream.
   
4. Timing: The timing of Suboxone administration is crucial. It is often started when the individual is in a mild to moderate state of withdrawal to reduce the risk of precipitated withdrawal. The healthcare provider will provide guidance on the appropriate timing.
   
5. Regular Monitoring: During Suboxone treatment, individuals are regularly monitored by healthcare professionals to assess progress, manage side effects, and adjust the treatment plan as needed.
   
6. Counseling and Support: Suboxone is typically part of a comprehensive treatment plan that includes counseling, therapy, and support services. This holistic approach addresses both the physical and psychological aspects of opioid addiction.
   
7. Gradual Tapering: Depending on the treatment plan, there may be a gradual tapering of Suboxone dosage as the individual progresses in their recovery. Tapering is done under medical supervision to minimize withdrawal symptoms.
   
8. Avoiding Other Opioids: It's crucial to avoid the use of other opioids while taking Suboxone. Combining opioids can lead to dangerous interactions and diminish the effectiveness of the treatment.
   
9. Side Effects and Reporting: Like any medication, Suboxone may have side effects. Common side effects include headache, nausea, and constipation. Any unusual or severe side effects should be promptly reported to the healthcare provider.
   
10. Pregnancy Considerations: If an individual is pregnant or planning to become pregnant, it's important to discuss this with the healthcare provider, as the use of Suboxone during pregnancy requires careful consideration.
    

Always follow the guidance of your healthcare provider and inform them of any concerns or changes in your condition during Suboxone treatment. Successful recovery often involves a combination of medication, counseling, and support tailored to individual needs.
Suboxone, when used as prescribed under the supervision of a healthcare professional as part of medication-assisted treatment (MAT) for opioid use disorder, has a lower potential for abuse and addiction compared to full opioid agonists. This is because Suboxone contains buprenorphine, a partial opioid agonist, which has a ceiling effect on its opioid effects.
Buprenorphine's partial agonist properties mean that it activates opioid receptors in the brain to a lesser extent than full agonists like heroin or oxycodone. As a result, the euphoria and respiratory depression associated with opioid abuse are less pronounced with buprenorphine.
However, it's essential to emphasize that any medication, including Suboxone, should be taken exactly as prescribed by a healthcare professional. Misuse, such as taking larger doses or combining Suboxone with other substances, can increase the risk of dependence or addiction.
Abruptly stopping Suboxone can lead to withdrawal symptoms, emphasizing the importance of a gradual tapering plan under medical supervision when discontinuing the medication. It's crucial for individuals using Suboxone to work closely with their healthcare provider to ensure proper management of their opioid use disorder and to address any concerns or side effects during the course of treatment.
Withdrawal symptoms from Suboxone, or buprenorphine (the active ingredient in Suboxone), can occur when someone who has been using the medication for an extended period stops taking it abruptly. It's important to note that withdrawal symptoms can vary in intensity and duration based on factors such as the individual's overall health, the duration of Suboxone use, and the dosage.
Common withdrawal symptoms from Suboxone may include:

1. Nausea and vomiting
2. Diarrhea
3. Muscle aches and pains
4. Sweating
5. Insomnia or sleep disturbances
6. Anxiety
7. Irritability
8. Runny nose and teary eyes
9. Goosebumps (piloerection)
10. Dilated pupils

It's important to distinguish between withdrawal symptoms and precipitated withdrawal. Precipitated withdrawal can occur if someone takes Suboxone too soon after using a full opioid agonist, leading to a more rapid and intense onset of withdrawal symptoms.
Withdrawal from Suboxone is generally considered less severe than withdrawal from full opioid agonists, and the symptoms tend to peak within the first 72 hours after discontinuation. However, the duration and severity can vary from person to person.
If an individual is considering stopping Suboxone or adjusting their dosage, it's crucial to do so under the guidance of a healthcare professional. Tapering the medication gradually, rather than stopping abruptly, can help minimize withdrawal symptoms and increase the chances of a successful transition to recovery. Seeking support from healthcare providers, counselors, and support groups is essential during this process.
Kratom is a tropical tree native to Southeast Asia, specifically in countries like Thailand, Malaysia, Indonesia, Papua New Guinea, and Myanmar. The leaves of the Kratom tree have been traditionally used for various purposes, including as a stimulant, a pain reliever, and to manage opioid withdrawal symptoms.
The active compounds in Kratom, called alkaloids, interact with opioid receptors in the brain, producing effects that can vary depending on the strain and dosage. These effects can include:

1. Stimulation: At lower doses, Kratom may act as a stimulant, promoting increased energy, alertness, and sociability.
   
2. Sedation: At higher doses, Kratom may have sedative effects, leading to relaxation and pain relief.
   
3. Pain Relief: Kratom has been used traditionally for its analgesic properties, and some people use it as a natural remedy for pain.
   
4. Mood Enhancement: Some users report improved mood and reduced anxiety after consuming Kratom.
   

However, it's important to note that Kratom is not regulated by the U.S. Food and Drug Administration (FDA), and its safety and effectiveness for various uses have not been clinically proven. There are potential risks associated with Kratom use, including dependence, addiction, and adverse effects such as nausea, constipation, and increased heart rate.
Due to these concerns, Kratom has been a subject of regulatory scrutiny in various countries, with some regions imposing restrictions or outright bans on its sale and use. It is essential for individuals to exercise caution, seek reliable information, and consult with healthcare professionals before considering the use of Kratom, especially for medicinal purposes or to manage opioid withdrawal.
Methadone is a synthetic opioid medication used primarily in the treatment of opioid dependence, particularly in the context of medication-assisted treatment (MAT). It is a long-acting opioid agonist, meaning it activates the same opioid receptors in the brain that other opioids, like heroin or morphine, do.
Key points about Methadone include:

1. Opioid Dependence Treatment: Methadone is often used as a maintenance medication to help individuals reduce or quit the use of illicit opioids. It helps by reducing cravings and withdrawal symptoms.
   
2. Long-Lasting Effect: One significant advantage of methadone is its long duration of action. A single daily dose can help stabilize individuals, preventing the highs and lows associated with short-acting opioids.
   
3. Supervised Administration: In some cases, methadone is provided through supervised administration in specialized clinics to ensure proper use and minimize the risk of diversion.
   
4. Tolerance and Dependence: Like other opioids, individuals using methadone can develop tolerance and dependence. Therefore, the dosage needs to be carefully managed, and discontinuation should be done gradually under medical supervision.
   
5. Reduction of Illicit Drug Use: When used as part of a comprehensive treatment plan, methadone has been shown to reduce illicit opioid use, lower the risk of overdose, and improve overall health outcomes.
   
6. Potential Side Effects: Methadone can have side effects, including constipation, sweating, drowsiness, and changes in libido. It's important for individuals to report any adverse effects to their healthcare provider.
   
7. Regulated Use: The use of methadone is tightly regulated, and it is typically dispensed through specialized clinics or healthcare providers who are authorized to prescribe it for opioid use disorder treatment.
   

Methadone treatment is part of a broader approach that often includes counseling, therapy, and support services. It has been a valuable tool in harm reduction strategies aimed at addressing the opioid epidemic and helping individuals achieve and maintain recovery.
Narcotics Anonymous (NA) is a 12-step program that provides support for individuals recovering from addiction, particularly those struggling with substance abuse issues. It is important to note that NA, like other 12-step programs, does not have an official stance or opinion on specific medical treatments, including medication-assisted treatment (MAT) for withdrawal.
The approach to medication assistance in withdrawal can vary among individuals within the NA community. Some may find success and support in MAT, while others may choose alternative methods or prefer an abstinence-based approach. NA encourages individuals to share their experiences, strength, and hope, but it does not dictate specific treatment choices.
The primary focus of NA is on mutual support, fellowship, and following the 12-step principles, which include admitting powerlessness over addiction, seeking spiritual awakening, and helping others in recovery. Members of NA are encouraged to respect each other's choices and paths to recovery.
It's essential for individuals seeking support for addiction to find a treatment plan that aligns with their needs and values. Consulting with healthcare professionals, attending support groups, and considering various treatment options can be part of a comprehensive approach to recovery.
SMART Recovery (Self-Management and Recovery Training) is a science-based, secular alternative to traditional 12-step programs like Narcotics Anonymous. SMART Recovery emphasizes self-empowerment and utilizes evidence-based techniques to support individuals in overcoming addiction.
Regarding Medication-Assisted Treatment (MAT), SMART Recovery takes a neutral stance. The program acknowledges that MAT, when prescribed and monitored by healthcare professionals, can be a valid and effective part of a comprehensive approach to addiction treatment. SMART Recovery recognizes that different individuals may have unique needs, and treatment plans should be tailored to the individual's circumstances.
SMART Recovery's focus is on teaching self-reliance, coping skills, and strategies for managing urges and behaviors associated with addiction. The program encourages participants to make informed decisions about their recovery, including the consideration of medications that may be prescribed by healthcare providers.
Ultimately, SMART Recovery emphasizes a holistic and individualized approach to recovery, allowing participants to choose the methods and tools that best suit their needs and align with their values. This includes being open to the potential benefits of MAT for some individuals as part of their overall recovery plan.
Several treatment modalities are available for individuals struggling with opioid use disorder. The most effective approach often involves a combination of different strategies. Here are some key treatment modalities for opioid addiction:

1. Medication-Assisted Treatment (MAT): MAT involves the use of medications, such as methadone, buprenorphine (Suboxone), and naltrexone, to help manage cravings, reduce withdrawal symptoms, and support recovery. These medications are often used in combination with counseling and therapy.
   
2. Counseling and Behavioral Therapies: Various forms of counseling and behavioral therapies are crucial components of opioid addiction treatment. Cognitive-behavioral therapy (CBT), contingency management, motivational enhancement therapy, and dialectical behavior therapy (DBT) are among the approaches used to address the psychological aspects of addiction and help individuals develop coping skills.
   
3. Support Groups and 12-Step Programs: Participating in support groups like Narcotics Anonymous (NA) or 12-step programs can provide valuable peer support, encouragement, and a sense of community for individuals in recovery.
   
4. Detoxification Programs: Medically supervised detoxification programs help individuals safely manage the acute withdrawal symptoms associated with stopping opioid use. These programs often serve as the initial phase of treatment.
   
5. Residential or Inpatient Treatment: Inpatient treatment programs provide a structured and supportive environment for individuals to focus on recovery. These programs may include a combination of medical supervision, counseling, and therapeutic activities.
   
6. Outpatient Treatment: Outpatient programs allow individuals to receive treatment while living at home. This flexibility can be beneficial for those with work or family commitments. Outpatient treatment often includes counseling, therapy, and medication management.
   
7. Holistic and Alternative Therapies: Some individuals find benefit from holistic approaches, such as acupuncture, yoga, meditation, or mindfulness practices. These can complement traditional treatment modalities and contribute to overall well-being.
   
8. Peer Recovery Support Services: Peer recovery support services involve individuals with lived experience in recovery providing support, guidance, and encouragement to others going through similar challenges.
   

The most effective treatment plans are often individualized, taking into account the specific needs, preferences, and circumstances of each person. Collaborating with healthcare professionals to develop a comprehensive and tailored approach can significantly enhance the chances of successful recovery from opioid addiction.
The withdrawal timeline for fentanyl, a potent synthetic opioid, can vary among individuals based on factors such as the duration and intensity of use, individual metabolism, and overall health. Fentanyl withdrawal symptoms typically start shortly after the last dose and follow a general timeline:

1. Early Symptoms (Within a few hours): Early withdrawal symptoms may include anxiety, restlessness, sweating, and increased heart rate. Individuals may also experience muscle aches and insomnia.
   
2. Peak Intensity (24-72 hours): Withdrawal symptoms usually peak within the first 24 to 72 hours after discontinuing fentanyl. During this time, individuals may experience more intense symptoms such as nausea, vomiting, diarrhea, abdominal cramps, dilated pupils, and flu-like symptoms.
   
3. Subsiding Symptoms (5-7 days): The most acute withdrawal symptoms generally begin to subside within about five to seven days. However, some symptoms, such as insomnia, anxiety, and mood swings, may persist for a more extended period.
   
4. Post-Acute Withdrawal Syndrome (PAWS): Some individuals may experience a more prolonged period of withdrawal symptoms known as post-acute withdrawal syndrome (PAWS). This can include lingering psychological symptoms such as anxiety, depression, irritability, and difficulty concentrating. PAWS can persist for weeks or even months.
   

It's crucial to note that fentanyl withdrawal can be challenging, and seeking professional help is recommended to manage symptoms safely and effectively. Medical supervision can provide support through the detoxification process, and healthcare professionals may use medications to alleviate specific withdrawal symptoms and improve the overall comfort of the individual.
The withdrawal process is highly individual, and some individuals may find additional support through counseling, therapy, and participation in support groups to address the psychological aspects of recovery. Always consult with healthcare professionals for guidance on the safest and most effective approach to fentanyl withdrawal.
Xylazine is a veterinary sedative and analgesic medication. It belongs to the class of drugs known as alpha-2 adrenergic agonists. While it is primarily intended for veterinary use, xylazine has been misused in some cases for recreational purposes, particularly in combination with other substances.
In veterinary medicine, xylazine is commonly used as a sedative and muscle relaxant for various procedures, including surgery and diagnostic imaging. It is often administered to calm and immobilize animals.
However, the use of xylazine outside of veterinary settings, especially when combined with other drugs, can pose serious health risks. Misuse of xylazine has been associated with adverse effects, including respiratory depression, cardiovascular issues, and central nervous system depression.
It's important to emphasize that the use of xylazine for recreational purposes is highly dangerous and illegal. The drug is not intended for human consumption, and its effects can be unpredictable and potentially life-threatening.
If you have concerns about substance use or encounter situations involving illicit drugs, it is crucial to seek help from healthcare professionals, addiction specialists, or local support services. Misuse of veterinary drugs or any substances not prescribed for human use can have severe consequences and should be avoided.
PAWS stands for Post-Acute Withdrawal Syndrome. It refers to a set of prolonged withdrawal symptoms that some individuals may experience after the acute phase of withdrawal from substances like opioids, benzodiazepines, or alcohol. PAWS is not limited to a specific substance and can occur with various drugs.
These symptoms are generally more subtle than the acute withdrawal symptoms but can persist for weeks, months, or, in some cases, years after discontinuing substance use. PAWS can vary widely among individuals and may include symptoms such as:

1. Mood swings
2. Anxiety
3. Irritability
4. Insomnia
5. Fatigue
6. Difficulty concentrating
7. Memory problems
8. Reduced impulse control
9. Cravings for the substance

PAWS can be challenging for individuals in recovery, as these lingering symptoms may contribute to relapse if not effectively managed. Supportive interventions, such as counseling, therapy, and participation in support groups, can be beneficial for individuals experiencing PAWS. Healthy lifestyle choices, including regular exercise, proper nutrition, and adequate sleep, may also contribute to the overall well-being of those in recovery.
It's important to note that PAWS is not experienced by everyone in recovery, and its severity and duration can vary. Seeking guidance from healthcare professionals or addiction specialists can assist individuals in managing PAWS and maintaining long-term recovery.
Quitting substance use "cold turkey" involves stopping the use of a substance abruptly without tapering or gradually reducing the dosage. It's important to note that quitting cold turkey can be challenging, and the level of difficulty varies depending on the substance, the duration and intensity of use, and individual factors.
If you're considering quitting a substance cold turkey, here are some general recommendations:

1. Seek Professional Guidance: Before making the decision to quit cold turkey, it's advisable to consult with a healthcare professional or addiction specialist. They can provide guidance based on your specific situation, assess potential risks, and offer support.
   
2. Create a Support System: Inform friends, family, or a support network about your decision to quit. Having a support system in place can provide encouragement, understanding, and assistance during challenging times.
   
3. Understand Withdrawal Symptoms: Be aware of potential withdrawal symptoms associated with quitting the substance cold turkey. Withdrawal symptoms can vary depending on the substance but may include anxiety, irritability, insomnia, and other physical or psychological effects.
   
4. Stay Hydrated and Nourished: Maintaining proper hydration and nutrition is crucial during the quitting process. Stay hydrated by drinking water and consuming a balanced diet to support your overall well-being.
   
5. Exercise: Engage in regular physical activity. Exercise can help alleviate stress, improve mood, and contribute to your overall physical and mental health.
   
6. Consider Professional Treatment: Depending on the substance and the severity of dependence, professional treatment options, such as inpatient or outpatient programs, may be beneficial. Medical supervision can assist in managing withdrawal symptoms and ensuring safety.
   
7. Therapy and Counseling: Consider participating in therapy or counseling to address the underlying factors contributing to substance use and to develop coping strategies for a successful recovery.
   
8. Plan for Triggers: Identify situations, environments, or emotions that may trigger the urge to use the substance. Develop a plan to cope with these triggers without resorting to substance use.
   

It's essential to approach quitting any substance with a comprehensive strategy, and individual circumstances vary. Seeking professional advice ensures that you make informed decisions about the best approach for your specific situation. If you are experiencing severe withdrawal symptoms or have concerns about quitting cold turkey, it is crucial to consult with a healthcare professional for guidance and support.
Tapering refers to the gradual reduction of the dosage of a substance, typically a medication or a drug, over a specific period. Tapering is commonly used in the context of addiction treatment, where it involves slowly decreasing the amount of a substance to manage withdrawal symptoms and minimize the risks associated with abrupt discontinuation.
Key points about tapering include:

1. Medication-Assisted Treatment (MAT): Tapering is often part of medication-assisted treatment for substance use disorders. For example, individuals dependent on opioids might undergo a gradual tapering of medications like methadone or buprenorphine.
   
2. Reducing Dependence: Tapering is employed to reduce physical dependence on a substance by allowing the body to adjust to lower levels gradually. This helps minimize the severity of withdrawal symptoms.
   
3. Individualized Approach: Tapering plans are typically individualized based on factors such as the substance used, the duration and intensity of use, and the individual's overall health. Healthcare professionals design tapering schedules to meet the specific needs of each person.
   
4. Supervised Tapering: Tapering is ideally done under the supervision of a healthcare professional to ensure safety and effectiveness. This is particularly important in cases where abrupt discontinuation could lead to severe withdrawal symptoms or complications.
   
5. Psychological Support: Tapering is not only about physical adjustments but also addresses psychological aspects of dependence. It provides individuals with an opportunity to develop coping skills and strategies for managing life without reliance on the substance.
   
6. Preventing Relapse: Gradual tapering can help reduce the risk of relapse by easing the transition to complete abstinence. It gives individuals the time and support needed to adjust to life without the substance.
   

Tapering is a careful and structured process that should be guided by healthcare professionals. Abruptly stopping certain substances can lead to severe withdrawal symptoms and potential health risks. Seeking professional advice and support is crucial for a safe and successful tapering process, whether it's part of addiction treatment or the discontinuation of a prescribed medication.
Engaging in activities during withdrawal can help distract from symptoms, provide a sense of accomplishment, and contribute to overall well-being. Here are some ideas for keeping busy during withdrawal:

1. Reading: Escape into a good book or explore topics of interest to keep your mind occupied.
   
2. Movies or TV Shows: Watch movies or binge-watch a TV series to pass the time. Choose lighthearted or inspirational content.
   
3. Exercise: Engage in gentle exercises like walking, yoga, or stretching. Exercise can help improve mood and alleviate some withdrawal symptoms.
   
4. Creative Hobbies: Explore creative outlets such as drawing, painting, writing, or playing a musical instrument.
   
5. Mindfulness and Meditation: Practice mindfulness or meditation techniques to calm the mind and reduce stress.
   
6. Gardening: Spend time outdoors, tending to a garden or plants. Nature can have a positive impact on mood.
   
7. Puzzle Games: Solve puzzles, play Sudoku, or engage in other mentally stimulating games.
   
8. Listening to Music or Podcasts: Create playlists of your favorite music or listen to podcasts on topics of interest.
   
9. Cooking or Baking: Experiment with new recipes and treat yourself to nourishing meals.
   
10. Journaling: Write down your thoughts and feelings. Keeping a journal can be therapeutic during withdrawal.
    
11. Educational Courses: Take online courses or watch educational videos on platforms like Coursera or Khan Academy.
    
12. Board Games or Card Games: Play board games or cards with friends or family for some social interaction.
    
13. Self-Care Activities: Take relaxing baths, practice skincare routines, or indulge in other self-care activities to nurture your well-being.
    
14. Volunteering: If possible, consider volunteering for a cause you're passionate about. Helping others can be rewarding.
    
15. Stay Connected: Reach out to friends and family for support. Having a support system is crucial during withdrawal.
    

It's important to choose activities that align with your interests and energy levels. Remember that withdrawal is a challenging time, and it's okay to prioritize self-care. If symptoms become severe or unmanageable, seeking professional help is recommended.