One day while I was teaching I felt a sharp pain in my T3/T4 area on the left side, then burning and itching for weeks. Went to a spinal specialist early on who took an Xray and said everything was normal. I was 25 at the time. Six months before that, I had finished my thru-hike of the AT and thought I had somehow compressed a small nerve carrying a cheap backpack that was too heavy.
I went to urgent care a year later and they took another Xray and confirmed it was a compressed nerve, and said some calcification was happening. I did some dry needling and that helped, but the facility was so careless. Sometimes I'd go to put my shirt on after a session and needles would fall off of my back and they'd say, "Oops, forgot a couple." So I stopped.
Ever since then, the pain has only progressed-- especially when I'm stressed or dehydrated. When I bend my torso left or right or twist, air escapes my lungs involuntarily through my throat and you can hear it if you listen closely.
Sometimes it's just excruciating. I got an MRI a year ago and everything came back normal. But recently I noticed that the skin on my ribs on the left side is kind of numb compared to the other side. The left is where I've had all the problems.
Ankylosene Spondilitis runs in the family as well. Should I get tested for that? What else could be causing this?

One day while I was teaching I felt a sharp pain in my T3/T4 area on the left side, then burning and itching for weeks. Went to a spinal specialist early on who took an Xray and said everything was normal. I was 25 at the time. Six months before that, I had finished my thru-hike of the AT and thought I had somehow compressed a small nerve carrying a cheap backpack that was too heavy.
I went to urgent care a year later and they took another Xray and confirmed it was a compressed nerve, and said some calcification was happening. I did some dry needling and that helped, but the facility was so careless. Sometimes I'd go to put my shirt on after a session and needles would fall off of my back and they'd say, "Oops, forgot a couple." So I stopped.
Ever since then, the pain has only progressed-- especially when I'm stressed or dehydrated. When I bend my torso left or right or twist, air escapes my lungs involuntarily through my throat and you can hear it if you listen closely.
Sometimes it's just excruciating. I got an MRI a year ago and everything came back normal. But recently I noticed that the skin on my ribs on the left side is kind of numb compared to the other side. The left is where I've had all the problems.
Ankylosene Spondilitis runs in the family as well. Should I get tested for that? What else could be causing this?

Three weeks ago, I thought I was dying. I was so sick, for three hellish weeks. The first week I was waiting for it to go away, then I got to a point I could barely breathe. So I went to the hospital where they horribly mistreated me and I left without treatment. Another week later and I had to suck it up and take the bus to the ER where they said I had pneumonia and a lung abscess.
About 12 days ago, a new depression medication I had been taking for a week prior caused me to experience horrific auditory hallucinations. This was the first time in my life I had experienced this, and it was so real, that after a week of torture, no sleep, all while not knowing it was the med causing it, I broke and called the police to go help my elderly neighbor who I was 100% convinced was being tortured in their apartment that’s connected to mine.
I had no idea I had a year old warrant from the girl my supposed former partner had been living with for two of the four years he said we were together. So the police checked on my neighbor, who was fine, and then came and arrested me.
While in jail for 8 days, I was not given any of my medications. Including the one causing the auditory hallucinations, which after two days they all stopped and that’s when I figured out that it had been the med that whole time.
While in jail, the sadistic sick guards put me with 14 other women in one small cell intended to hold 8, for almost 36 hours. They didn’t even give us water that entire duration. Two of the girls sitting next to me were complaining of sore throats. Yesterday I woke up with a cough, and today I’m coughing up green and grey yet again. I feel flat out like walking death.
When I got out of jail, which I had never been to before, nobody told me I needed to go directly to the bondsman and sign paperwork. So they called me last night and said if I don’t come in they will revoke my bond. They are in a city two hours away and I do not drive due to massive amounts of head trauma which caused a balance disorder.
Now I have to get two bus tickets, a Lyft to and from the bondsman, and only have $60 to do all that with. The woman that the SSA put in charge of my money at first, did not pay all of my rent last month, so I had to give my landlord $120 when I got out of jail, after finding an eviction notice warning letter on my coffee table when I got home.
I am in the middle of trying to pull together a move to NC after receiving a letter one week before I was arrested, saying that I had finally come up on the waitlist for Section 8 out there after years of waiting.
Today I had to make the decision on the lawyer I wanted to hire to help me with my trial since I am clueless about anything to do with law and don’t want to go back to jail.
I have a billion things to do this week still, including spending however many hours at the SSA tomorrow so I can get enough $ released early to pay my attorney fee so she can begin working on my case before the trial next month. I can barely stand up at this point, this just hit so hard so fast.
I’m so overwhelmed and none of this can be put off even a week. I haven’t eaten since I got out of jail 4 days ago cause all my food went bad and I have to give and save every dime now, part went to my landlord and the rest I need to get to the city my bondsman is in and make it home.
I cannot even believe this fucking shit.

Credit to u/SpacePaladin15 for the NOP Universe.
Hey, I hope everyone's doing well!
Today we return to the namesake of this fic, an actual lesson about animals. This one focuses on Koalas! One of Australia's most recognisable critters. I hope you enjoy.
It's hardly worth mentioning, seeing as I'm an infrequent poster at the best of times, but I'll not have another chapter out for a few weeks due to limited free time and devoting most of my writing time to an upcoming ficnapping. Be sure to look out for that!
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Memory transcription subject: Rysel, Venlil Environmental Researcher
Date [Standardised human time]: 8th September 2136
“Koalas!”
Bernard’s energised voice boomed through the air as the classroom's monitor flickered into life, images of this paws lecture topic popping up one after the other until the entire screen was filled with a collage of furry quadrupeds.
Squee! I’ll never get tired of this, it’s all so cool!
As usual the sight of something new stirred immediate discussion, hushed murmurs swelling into vibrant discourse in little more than a heartbeat. Most of the class swiftly huddled together into small herds to bounce ideas around while the rest opted to stick to the solace of their own thoughts as they took in the display.
I’d be quite happy in either situation, though seeing as Sandi had already sunk into deep concentration and Kailo had peeled off to talk with Ennerif and Solenk, it seemed the decision had been made for me on this occasion. Wasting no more time on idle inspection of the people around me, I focused my full attention forward, eager to form first impressions before the lesson began in earnest.
Now then, time to make some educated guesses. What traits does this animal have? I wonder if I’ll get any right this paw?
Professional assumptions went paw-in-paw with the lectures, examining and coming up with hypotheses about the specimens was only natural. Recently however, I’d started to make a little game of it to make things even more interesting than usual. A veritable bonfire of ideas had been set ablaze within me, fueled by my newfound knowledge of Earthen wildlife. Every flash and spark of the flame was a fresh theory I could try to apply to the lectures. It was an invigorating exercise that further stoked my unceasing wonderment.
So far I’d only done this once during the previous class and, to my disappointment, I’d not done too well.
I was right when I guessed that chickens were omnivores, but wrong in my assumption that they could fly. And that red thing on their head, the um… what was it called? The comb! Yes, the comb. I thought that was to attract mates, but it regulates body heat instead. It’s fascinating. Oh! Stars damn it I’m rambling!
I bapped my tail against my leg, the soft thud being just enough to snap me back from my runaway thoughts before I went completely wall-eyed. I was becoming more and more accustomed to getting lost in my own head while remaining conscious of the fact; it was happening so frequently now that it was pretty much impossible not to. Now I was able to pull myself back to the world around me without having to rely on someone else shaking me out of it. Most of the time anyway.
Sandi still keeps an eye on me, and Kailo even decided to help out once without being too snide about it. Anyway where was I? Oh yeah, Koalas.
Glancing at the furred animals, two things immediately stood out. Firstly, their eyes were in a more central position on their face. And second, all the images showed them being on or close to trees. There were other noteworthy observations of course, such as the Koala’s prominent nose and rounded features, but they fell to the wayside as I honed in on these points first.
Hmmm… ok. I already know to discount the idea that they’re predators just from eye position, so let’s get that thought out of here. Maybe omnivorous? Herbivore? Agh no, I can’t just guess that for the sake of guessing, that’s the same problem! Hrm, it’s tough making these assumptions now that everything I thought I knew has been turned on its head.
Nevermind, I’ll focus on the other thing. All the trees make me think they’re arboreal, that seems to be a reasonable assumption. I wonder what else they-
Clearing his throat, Bernard broke my concentration, his call for attention silencing the murmuring conversation and redirecting everyone's focus to the lecturer's podium.
His gaze panned across the room as he waited for everyone to settle, a beaming smile lighting up his face, “As ever I’m delighted to see you all get so into the subject matter from the get go. I’m looking forward to hearing what you were discussing should you wish to share. For now though, how about we get started, hm?”
A chorus of merry bleats rang out from across the audience, ears and tails flicking happily in agreement. Bernard's grin grew in tandem with the class's fervour, clasping his hands together enthusiastically as he launched into the lesson, “Excellent! Then let’s get started.”
The pictures on screen dissolved away until only one remained, enlarging to cover the entire monitor with the fluffy grey face of a Koala peacefully reclining in the crook of a tree.
“Ah, there we are,” Bernard’s baritone timbre drifted through the room as he looked up at the image, his own tone reflecting the relaxed attitude of the animal on screen, “He looks so comfortable doesn’t he? Perfectly at peace with the world, not too surprising considering they sleep almost 20 hours a day. A full paw!”
A wave of beeps and gasps rippled through the herd, punctuated by a single yawn-dressed comment from Rova, “A full paw? Hwuuu… jealous.”
Her drowsy remark elicited several whistling giggles from the herd, Bernard's own jovial chortle joining them as he turned to face her, “Late evening Rova?”
I twisted a little in my seat, panning an eye in Rova’s direction just in time to see her bleary eyes bulge open and her ears shoot up, now intensely aware of the fact she hadn’t been as quiet as she thought she had.
Sitting up abruptly, she hastily tapped down errant tufts of wool that’d flared in surprise as she composed herself, though her nervousness at becoming the centre of the class's attention was still plain for all to hear, “Uh- I um… achem, a little bit yes, um- …sorry. Lokki dragged me out to a movie viewing in the rec centre. It went on pretty late.”
A melodramatic bray from the other side of the room drew everyone's ears away from Rova to the now aghast Lokki, paw splayed across his chest in faux indignation, “Dragged you? Well excuse me for trying to broaden your horizons with human movies. That’ll be the list time I- …Ahaaaa…”
Lokki’s theatrics were cut short by a heavy yawn of his own, a swell of whistling laughter rolling through the herd as vibrant bloom lit up his snout, a sight that elicited a particularly amused bleat from Rova.
Turning away from the duo I looked back at Bernard, pleased to see that he was chuckling along with us. Behaviour like Lokki’s would never have been tolerated in my school and university days but, in stark contrast, Bernard revelled in it, the liveliness of his students fueling his own bombastic style of teaching. It was a pleasant change of pace having a teacher who let us all be ourselves in class; provided we weren’t too disruptive to the lesson plan.
Speaking of which.
His laughter still rumbling through the air, Bernard clapped his hands to pull everyone's focus back to him, “Ok, ok, let’s get back to it then shall we? Rova. Lokki. Hopefully the two of you can stay awake long enough until you can grab yourselves a coffee.”
As the class settled down and the last few giggling beeps petered out, Benard pointed a hand to the screen, “So, the Koala. Let’s start simple shall we? They are herbivorous marsupials native to the eastern and southern coasts of Australia. Easily recognised the world over, they are a well known and beloved symbol of their homeland, along with other animals such as the Kangaroo and the Emu. The former of which you might remember from one of our earlier lectures.”
Indeed I did remember, along with how angry Bernard had gotten after some speh-head had derided the Yotul after he explained how he held specific disdain for such attitudes.
Uuuggghh… I never want to see him angry again. So chilling.
I shook my ears in an effort to dismiss the unpleasant memory, panning my eyes back to the monitor to try and distract myself by inspecting the Koala’s physical appearance once more. Thankfully, by some Star's blessed intervention, Bernard had the exact same idea.
“Koala’s are rather squat in stature, ranging around sixty to eighty-five centimetres in length and weighing little more than fifteen to sixteen kilograms at their full size. As you can see, the fur of this fellow before you is a lovely silvery grey, but their fur can also sport a chocolaty brown hue as well. Arguably the most distinctive part of their appearance is their head, being rather large for their body size and having rounded ears, a large nose, and a pair of small eyes. These are often brown but variations do occur.”
It didn’t slip past my notice that Bernard didn’t bother to point out that the Koala’s eyes were forward facing. I didn’t think he’d simply forgotten, so perhaps he just felt it wasn’t necessary given that he’d already stated it was herbivorous. Either way, no one stuck up a paw or tail to question him.
“Now this will hardly be surprising considering how long they sleep, but Koala’s are largely sedentary and it’s rather easy to see why when you have a look into the contents of their diet.”
With the press of a button the Koala on screen was replaced by images of vibrant green vegetation. Soaring trees and flowering shrubbery weaved together across landscape framed pictures pulled admiring trills from the herd, the diversity of the plant life being shown standing as a reminder that it wasn’t only animal life that flourished on Earth.
After giving everyone the chance to take in the picturesque scenes, Bernard casually hammered that point home, “This is eucalyptus or, more accurately, a choice selection of more than 700 plants belonging to the eucalyptus genus, though the Koala itself favours 30 of them in particular.”
700!? Stars…
Realising that my ears had drooped in my momentary awe, I twisted them back to tune into the lesson, only for them to splay out in shock at the next words to come out of Bernard's mouth.
“The leaves of these plants are the primary food source of the Koala and there are a couple things worth mentioning when talking about these plants. For starters they do not have much nutritional or caloric value, leading to the Koala’s low-energy lifestyle. Additionally, they contain toxic compounds.”
A shiver instantly ran through the herd, ears flicking rapidly in confusion and alarm followed by a few quizzical whispers. It didn’t take long for someone to decide to give a proper voice to the murmuring.
“Excuse me Doctor. Did we hear that right? Their diet is made up of toxic flora?” Vlek’s grumbling incredulity cut through the herd's mutterings with ease. Until Kailo’s recent change of heart, the fifty something rotation old blonde Venlil had been a close second in terms of scepticism. Mercifully his rebuttals had always been relevant questions as opposed to ranting diatribes, so he at least remained on topic if nothing else.
Bernard nodded in confirmation, smiling back at Vlek while absentmindedly twirling the end of his moustache, “You heard me right, they do indeed consume plants that are toxic. Just not to them.”
Any worry or uncertainty still clinging to the herd was swept away by the provision of the glaringly obvious answer, leaving me chuckling inwardly at the oversight.
Ah of course! The plant might be poisonous but they’ll have evolved to deal with that. Stars… I’m so used to expecting the unexpected with Earth that I didn’t even consider the simplest solution.
“I see, thank you Doctor,” Vlek replied, a tinge of interest still audible in his tone, “I assume they’ve developed some adaptation to become immune to the harmful effects?”
The question immediately evoked a smirk from our teacher, but he hurriedly suppressed it while bobbing his head, “They have indeed. There are several factors that aid in their digestion of eucalyptus leaves without succumbing to the plant's baleful properties. The first is a part of the intestinal tract called the cecum. It contains a microbiome that allows the Koala to digest the eucalyptus. Coupled with this is an enzyme in the Koala’s liver that helps them break down the toxins. They are also capable of sniffing out the plants with the least amount of toxins, ensuring that they ingest as little as possible.”
Pausing for a breath Bernard looked back at the screen before turning to face us, another grin curling at the edges of his mouth as he continued with his explanation, “This is mostly for adult Koala’s, because while their young also possess these same adaptations, they don’t just go straight to munching through foliage right after being born. No, they need a little help making that jump and getting a stomach full of all that good gut bacteria. It’s nothing bad, but those of a sensitive stomach may wish to prepare themselves for this next part.”
Bernard’s assurances did little to assuage the concern that his warning had foisted upon us. Having been exposed to so much of the weirdness Earth had to offer everyone always ended up on edge whenever Bernard gave advice like this, even if he did say it in jest.
What strange nonsense thing do Koala pups do then? Judging by the way he’s acting it probably isn’t something as simple as drinking milk from the mother. Hmmm…
“So,” Bernard began, snapping us from our pensive stupor, “Young Koala’s, known as joeys, have a gestation period of thirty-five days on average, which is approximately forty-two paws. Once born they travel from the birth canal to a pouch in their mother so that they can continue to develop and grow. In the pouch the joey finds and latches onto one of two teats and these provide the newborn with a steady stream of nourishing milk. It spends the next six to seven months growing in the pouch, its eyes, ears, and fur all developing as time goes on.”
Okay, interesting. But this is exactly how I thought it’d go. What’s different?
The unexpected normalcy of the Koala’s birth and growth cycle had calmed everyone's nerves, only to be replaced with an air of suspicion as we waited with rapt attention for Bernard to drop the other claw and upend our expectations like he always did.
Not wanting to keep us in further suspense he forged ahead, the tempo of his voice picking up as the smile started to crease his face once more, “Now to make the switch from milk to eucalyptus, the mother also feeds the joey a substance called pap. It comes from the cecum I mentioned earlier, and contains all the gut bacteria required to help the young Koala in making the switch to eucalyptus.”
He stopped and looked around, searching us for a reaction to what I felt was a rather bland statement of fact. What was it he was saying without actually saying? Koala pups drink milk to mature and then include this pap substance so that they can start eating plants. I don’t see what-
The cecum is part of the intestine.
I blinked.
I blinked again, the intrusive interruption scouring my brain clean of any other thought bar the one it’d just implanted itself in the forefront of my mind.
Oh stars. They-
“They eat their own poop!?”
The shocked bleat shattered the peace of the room to reveal that most if not all of us had come to the same tail curling conclusion. As the hall filled with unrestrained vocalisations of disgust, an ‘Ugh’ over here and a ‘Blegh’ over there, Bernard’s own bellowing laughter joined the throng of voices.
“Ha! Everytime! Each and every time. Clearly it doesn’t matter if my students are Human or Venlil. Whenever someone learns about the Koala’s dietary development the reaction is the same!”
Pleased with himself beyond reason, Bernard chuckled away while the rest of us grappled with this ghastly reality. While there were plenty of animals that feasted on things that ranged from simply unappealing all the way to the stomach churningly grotesque, I’d never heard of an animal that actively consumed the excrement of its own species. Benefits aside, the prospect of having to do that to survive to adulthood sent a shiver of revulsion down my spine.
Ewww… Stars, I hope I forget this feeling by 2nd meal. They’re serving sturen and magamroot stew later. I was really looking forward to it.
With the herds mood beginning to temper Bernard tapped the podiums controls, removing the verdant collage of eucalyptus to display several similar yet distinct environments, still chortling merrily to himself in the process, “Ok then, with that little foray into their diet complete, why don’t we look at their habitat in more detail? As you might imagine given their diet and arboreal nature, Koala’s live in forested regions, and can be found in tropical and temperate zones. About a century ago they were classed as a vulnerable species, however efforts were made to turn this around and increase their numbers. Sadly the largest factor in their decline was human activity, as the fertile lands that gave rise to their bountiful forests were coveted farm land for our settlements.”
It was strange to hear Bernard so matter of factly admit to humanity's negative impacts on other species. He’d alluded to such things in the past but always with an air of caution, carefully pawing the line between honestly answering a question while not painting humanity as uncaring and destructive. AKA, the ‘predators’ we’d all initially expected them to be.
Perhaps his comfort in making such admissions was a reflection of the class's comfort with him, for no one so much as batted an ear. Even Kailo, who I would’ve expected to jump at the chance to use this as a prime example of predatory danger, only flicked an ear in stern yet silent concern.
A cough from Bernard drew my attention back, a new picture on screen that showed a forest from a bird's-eye view. Drawn across the image were around a dozen ringed areas, some bordering one another while others overlapped to some degree. It took me a moment, but I soon recognised that what I was looking at was a map, the rings representing what I assumed to be territories. And it didn’t take much effort to guess who each one belonged to.
“From habitats we move onto behaviours, so let’s start with territories. Koala’s are solitary animals. Yes, despite being herbivores. Considering they’re only awake for roughly four hours of the day I can hardly blame them. Lots to do and not a lot of time to do it. Jokes aside, once they mature they are quite independent, carving out a little slice of land for themselves, as displayed in this example, called a Home Range. That is not to say they go it alone and leave everything else behind however. Rather, as shown in the map behind me, they live in their own space while still being part of a larger social group.”
With another press of his pad the picture was updated to show one of two symbols in each segment, along with a key to the side of the map displayed in helpful Venlang. A quick glance told me that the symbols were representing whether the territory belonged to a male or female of the species.
“As you can see there is quite a bit of overlap between different Koala’s territories. It is in these areas that most of the socialising takes place between neighbours. The trees in these locations represent the few areas where intrusion across territories is acceptable for the sake of social interaction. Outside of that the Koala’s stick to their own territories for the most part, with the exceptions of Koala’s who are passing through, attempting to become part of the social group themselves, or dominant males who sometimes go off into another Koala’s range. But how do they know where one range begins and another range ends you might ask? Well, this brings us onto the next part of the lecture. How do Koala’s communicate?”
Wiping away the map from the monitor, Bernard loaded up a video of a Koala sitting in a tree and pressed play. Head held high, the Koala’s body shook as it belted out a reverberating call into the wilderness that could only be described as a garbled combination of a car engine failing to turn over mixed with the hiccups of someone with a particularly sore throat.
That’s how they sound? Oof that must be rough on the lungs.
I clearly wasn’t the only one to share such a thought, because I clocked Sandi tracing a paw along her neck as the noise went on, ears fluttering in discomfort at the noise.
Bernard himself cleared his own throat as the video came to an end, minimising it and replacing it with another image of a tree with a Koala rubbing up against the bark, “I think they’ve got me beat on who’s got the deeper voice!”
His joke garnered several amused beeps, a rare reaction that caused a beaming smile to shine across his face at lighting speed, “Oh you’re too kind. I’ll be here all week. Now where were we? Oh yes! Communication. As you’ve just heard, Koala’s are capable of loud low pitched bellows that can carry over vast distances. These express everything from ‘Hello I’m over here’ to ‘This is my turf, stay away’. Bellowing is more common in the males than the females, opting for shouting matches as opposed to outright fights when it comes to asserting dominance. Other vocal expressions include grunts, wails, and snarls if they’re acting particularly angsty. Mother and joey pairs also communicate through gentle clicking, squeaking, and murmuring sounds. And there’s one more thing worth mentioning. Something they have in common with Humans and Venlil when it comes to emoting.”
Really? They do something we do?
Curious, I pressed myself against the desk, straining as close as I could to once more scrutinise the Koala’s features. Not a lot stood out to me at first, the grey marsupial not sharing many similarities with a Venlil that I could identify.
Ok think. We show emotion with our ears, tails, and our wool on occasion. They don’t have tails so it’s obviously not that. Wool standing on end is more a reaction than a conscious expression. So it must be the ears then.
To my quiet satisfaction, my hunch was soon validated by Bernard, “As well as their vocalisations, Koala’s are very emotive through their facial features. Just like humans, they use their mouths and lips to show how they feel, but these tend more towards the aggressive side of the scale than what you might see on a human. Regarding yourselves however, Koala’s utilise their ears in tandem with their mouth movements when showing strong emotion.”
I was delighted to hear that my assumption was correct, a little happy flick twisting out through my tail and bapping against my chair with a muted thump against the plastic.
Hehe yes! Got one right!
“Now then, we are getting close to lunchtime so I’ll finish this segment off with something I think you’ll find particularly interesting. Diplomacy.”
Perplexed mutterings followed in the wake of the bizarre inclusion to the lecture, my own thoughts being dominated by bewilderment as I tried and failed to make sense of how the two could possibly be related.
Why would Koala’s, or any animal for that matter, be linked to diplomacy? Hmmm...
I could understand dispatching exterminators to deal with a predator issue as a show of goodwill, that at least includes animals, but Humans aren’t like that so I think I can safely scratch that off the list.
Maybe the humans who live in that region benefited from Koala’s in some way. Could they have gotten something from them? But what?
Hopefully not what the pups get from their mothers.
Agh no! Begone awful intrusive thoughts. Blegh! I don’t need that in my head.
As I wrestled with the short-lived revulsion inflicted upon me by my Star's damned subconscious, Bernard placed a new image on screen, one that was decidedly different from all that had preceded it.
On screen were more than a couple dozen pictures of humans. Some were pictured alone while others congregated in large groups while cameras surrounded them from all angles. Across all the images, I noted two common themes. First of all, a solid majority of the humans were wearing formal wear similar to what I’d seen worn by UN representatives on TV. If the gaggle of journalists in the background of the photos didn’t already confirm my suspicions, then it was this similarity which made me conclude they were all people of some importance. Likely politicians judging from context clues.
Secondly, each of the individuals was interacting with a Koala in some form. Some cradled one against their chests while others were feeding it eucalyptus leaves or pellets of some kind. One of the assumed politicians had become an impromptu bed for a snoozing bundle of fur, a gleeful smile spread across their face as they lovingly gazed down at the sleeping Koala in their lap.
As I continued to stare at the assorted photos something clicked into place, a sudden spark flickering into life. A burgeoning light of comprehension that flared and swelled with every wide-eyed breath I took. Some things still escaped me, things I hoped would soon be explained, but in staring at all of the humans happy smiling faces, I was struck with an instant of pure understanding.
If someone, say a Nevok for instance, offered to gift me a creature that was common to them but which might exotic and breathtaking to a Venlil, how could my feelings not be swayed? How could I walk away from that encounter and not have grown closer to them as a result?
“Koala diplomacy,” Bernard waved his hand up at the monitor, a slight reverence in his tone, “My favourite kind of soft power diplomacy. Where political leaders take photo ops with Koala’s and, on occasion, the Australian government loans Koala’s to other nations for a time to bolster positive relations. It certainly helps that Koala’s are a beloved animal worldwide, drawing large crowds and revenue for countries fortunate enough to host the adorable critters.”
The truly alien concept predictably sparked instant discussion in the herd, two polar opposite schools of thought swiftly cementing themselves as the most popular opinions. Simultaneously, I heard one voice trill excitedly while another scoffed at what they clearly saw as a ridiculous and offensive notion.
“Squee! That’d be so cool! I’d love to get the chance to see a Liri from Coila. Remember the Rainbow Boa? Think of that shimmering effect and colour but put it on a bird! Ah! I’ve only heard their song on video. It’d be a treat to hear it in person!”
Ooo! I’ve read about them! I’d love to get up close to one.
“Loaning. As if animals are property to be hoarded and traded? Pugh! Another predatory trait the humans don’t want to acknowledge for what it is.”
Ugh, typical. Jump right to the worst possible option.
However, despite my dismissal of their disparaging fumings, an uncomfortable thought pressed upon my mind. While it was plain to see how much humans cared for the Koala, it didn’t change the fact that humans did keep animals as property just as the scornful herd member had said.
This begged a rather important, disquieting question. Aside from keeping some animals as cattle, a stomach tightening minefield I had no desire to step a claw onto right now, how else did humans keep other creatures. And how did they treat them?
Before I was fully conscious of doing it my paw was in the air, the question primed on my tongue.
Noticing my elevated paw Bernard pointed at me, smiling warmly, “Yes Rysel? What’s on your mind?”
Sorry Bernard. I hope this one’s not too awkward for you to answer.
Flicking my ear in appreciation, and waiting for everyone to settle enough so that I could be heard, I voiced my concerns as neutrally as possible, “Thank you Doctor. I uh, just had a thought. We know that humans keep certain animals for… particular reasons, and we know why. From how you’ve spoken about Koala’s I think it's fair to say that the same cannot be said for them. However, this makes me wonder, what other reasons do humans have for keeping animals and how do you treat them?”
A flash of surprise blinked across Bernard's eyes but vanished so quickly that it felt like I’d imagined it. Had he not expected such a question? Maybe he was just shocked that it’d been me who’d ended up asking it?
Stars, am I so predictable that no one expects me to ask difficult questions?
Unfortunately, a quick glance at my deskmates seemed to prove that to be the case, as both Sandi and Kailo were looking at me with differing degrees of astonishment flapping in their ears.
Well speh.
“A very good point Rysel, certainly one that’s worth raising. Yet another example of you all anticipating what I have to say before I can bring it up myself.” Bernard tapped the podium, switching off the monitor before returning his focus to me, “We won’t be needing that. I’ve nothing prepared that I can show you and we’re heading to lunch in a few minutes anyway. Still, that’s plenty of time to give you a bit of an answer.”
A bit? What does he mean just a bit?
Made even more curious by Bernard's preempted admission that he wasn’t going to fully answer my query, I dialled both my ears on him, fixing him with an inquisitive stare as he started to explain with a tone that was noticeably more nonchalant than any of his previous explanations.
“So, animals in captivity for reasons other than what you already know. Honestly I would love to delve into other reasons regarding why we keep animals. However, I have a lesson plan in the works that I hope to share with you all in the not too distant future. Some of it touches upon this very topic and I’d quite like to bundle it all together. That said, I can tell you how animals in captivity are treated. In short, the answer is very well. There are a mountain of laws both on private and public interests that govern the standards and ethical treatment of animals, and breaches of these laws are quite severe even for relatively minor infractions.”
While I’d be lying if I said I wasn’t disappointed by the vague answer to what was really the bulk of my question, I was at least satisfied by Bernard’s assurances that animals in captivity, such as the Koala, were well looked after. Considering the barely subdued grumbling coming from some corners of the audience it was clear that several of the herd didn’t believe Bernard outright, but I trusted him to be honest. Additionally, the mention of an upcoming lecture focused on humans keeping animals caused quite the buzz.
I felt a mix of excitement and trepidation at exploring the topic further. He’d pretty much confirmed we wouldn’t be talking about cattle farms, for which I was relieved, but that still left a huge amount of uncertainty in what was to come.
Humans keeping animals as cattle was a forgone conclusion. As horrifying as that reality was, it was one I could understand from a detached and strictly clinical point of view. Being predators they ate meat and therefore they kept cattle. But the concept of keeping animals for any other reason baffled me.
What could be the purpose? The diplomacy thing makes sense now that I have context, but what other reasons could they have.
The class's discussions were interrupted by the recognisable ring of the break bell, the shift in attention eliciting a change in conversation from confused hypotheses to peppy conversation on how everyone was planning to spend their break and what they had in mind for 2nd meal.
“Well I can see everyone’s excited for lunch, and who am I to disappoint,” chuckling Bernard waved us all up from our seats, pocketing his pad from the podium and heading to open the classroom door for us, “Enjoy your break, get a good rest along with a hearty meal, and I’ll see you all back here at the usual time.”
As everyone else filed out I stayed behind, waving at Sandi and Kailo as they left, and pawing over to Bernard once he and I were the only ones left in the room.
Ears folded down and with an apologetic tinge in my voice I greeted him as I sidled up to him, “Hey Bernard, I uh… sorry if that last question was unexpected.”
Chortling in reply, Bernard waved a hand through the air in a sign I’d come to understand meant ‘not a problem’.
“No need to apologise Rysel. It was a good question and most certainly not a problem.”
Heh, called it.
I sighed, allowing tension I didn’t realise I’d been holding to relax itself from my shoulders, “Phew, that’s a relief. I’m glad. I’m curious to hear what this new lesson is you’ve got in store for us by the way.”
Bernard wagged a finger at me, throwing up his eyebrows in mock amazement, “Oh are you now? Well I’m afraid you’ll have to remain curious for the time being. It’s going to be quite the surprise if all goes to plan. But…”
He trailed off, glancing at me before looking to the door like he was making sure no one else was around.
Wait, is he going to tell me? Oh please yes let me know now!
Stopping myself from jumping on the spot in excited anticipation, and trying my damndest to stop my tail from wagging in equal measure, I stared up at Bernard as he stewed in his thoughts before turning back to face me.
“I can’t tell you the specifics, but I’m working with Alejandro and Tolim to get something together. A trip that’s not a trip as it were. And when it happens, I’m going to need a few of the more accepting members of the class to lend me a hand. I’m hoping you and a couple others will be able to help with that?”
A trip that’s not a trip? What does that mean? Agh who cares about that right now! Bernard’s relying on me to help out!
Still trying not to keep myself from bouncing around with pup like glee I swished my tail and nodded my head in joint agreement, happy to help with whatever Bernard had in store for us, “Of course! Anything you need I’ll be there to lend a paw. You can count on me!”
A broad warm smile lit up Bernard's face, a hand patting me on the shoulder in appreciation, “Thank you Rysel. I knew I could rely on you but it still warms my heart to hear it. And, as thanks for this and for the many times you’ve shown your support, the surprise includes a little something special I think you’d appreciate the most.”
If my earlier enthusiasm had been at a nine, then the implication of a supposed gift sent it rocketing all the way to a hundred in a heartbeat.
“Wait… WHAT!? What do you mean? What are you doing?”
As impossible as it seemed, Bernard's grin grew even wider as I almost lost myself in wool shaking exhilaration, “Call it my own form of Koala diplomacy. But I’m afraid that’s all I can say for now. Wouldn’t want to ruin the surprise even for you!”
“Oh you ass!” Whistling jovially I bapped my tail against Bernard’s leg in fake indignation, evoking a barking bellowing laugh from the man himself.
Still laughing, the two of us departed the class and made for the canteen, my rumbling stomach leading me on while my mind spun with fantastical thoughts as to what Bernard had prepared for us.
And what specifically he had in store for me.

This morning I woke up and cleared my throat and hacked up a bunch Of dark blood clots and bright red blood. I’m not sick, no cough, or anything. Has this ever happened to anyone before? I don’t feel like I had a bloody nose as my sheets were clean. I don’t really have a regular primary care physician so the one I saw just chalked it up to dry air and sleeping with a fan on? I’m 26 weeks pregnant and not sure I entirely believe him

Hi all! First off, so glad this sub reddit exists because it was a life saver when I was making decisions on my own ACLr and knowing what to expect from surgery. I'm a 2x cancer surviver, Paramedic, Rugby player, and now have been a caregiver to my partner who just celebrated 3 months from her own ACLr. I collected a bunch of advice and tips and tricks that I have used both during cancer treatment, my own experience with ACLr, and now through care taking my partner through hers. I know there have been guides before, but mine is a bit different and aimed at caregivers so I thought I'd post it here since ya'll helped me so much instead of it just circulating the rugby community every time a teammate or friend has to have ACLr or some other reconstruction. Hope it's allowed and helps!
A Cancer Patients Guide To Knee Reconstruction Recovery
A Comprehensive Guide To Surviving and Thriving In the Pre and Post-op Period Built From The Perspective of Caretaker and Patient.
Before The Date
__/__/____

Preparation

It is important to adequately prepare for surgery in the weeks and days leading up to the procedure. A significant period of immobility and reliance on support can be expected immediately post-op and will vary by procedure and personal experience. Physical modification of living space and thorough preparation allows for the immediate post-op period to be free of emergency store runs and the small inconveniences that can add up to big frustration. Not having food and drink nearby as well as other essentials may be a small deal now, but can turn into a big deal when you can no longer get those things for yourself. While physical preparation (home modifications, adaptive tools, meal prepping, etc.) are important, mental preparation is crucial to the long term success of the repair. Making small, achievable goals in the immediate post-op period and maintaining a long sighted view of recovery will make the pain and immobility that is initially experienced more bearable. Additionally, social support through a partner, family members, or friends is an essential part of recovery, as is maintaining contact with sports teams or other social groups during rehabilitation.

General PEARLs

• Pre-surgical rehab is an essential part of recovery and can improve immediate outcome so if it is a resource available to you- use it!
• Learn the basics of your procedure such as reconstruction technique, graft type, surgeons recovery timeline, where you will do your rehab, and what you should expect going into and coming out of surgery. Knowledge is power and can give a sense of control and set reasonable expectations in a situation that is otherwise out of your control.
• Seek out positive experiences and recovery stories from other people who have had your procedure and gather as much advice as possible from resources such as ACL. Know that some people will have negative experiences, everyone is an individual, and that much of your long term recovery is in your control.
• Expect and learn to advocate for yourself or the person you are taking care of. Be vocal and honest with any needs you may have and understand that issues may come up in the immediate post-operative time that you as a patient or caregiver may have to contact your surgeon to resolve. Familiarize yourself with who to call and when *before* you leave after surgery, as well as being quick to call with any questions or problems that arise. It is better to be told that what you are experiencing is normal than to sit with the anxiety of the unknown.
• Create a folder with all relevant information: Surgeons name, procedure information, follow-up appointment dates and times, phone numbers, emergency contacts, facility of choice in an emergency situation, and any other important information. Maintain this folder throughout your recovery and add paperwork as it comes.

Days Leading Up To Surgery

• Contact support people and confirm any arrangements that have been made including but not limited to: Who is taking you to/from surgery, child or pet care, transportation to first PT appointments, meals, etc.
• Recommended Items we found essential:
  • Ice Machine (Polarcube, etc) if at all possible
    • Recommend checking facebook marketplace or other second hand options, as they cost hundreds new but can be found for $40 or so used.
    • Studies have shown these do actually reduce pain and lend to earlier mobilisation and our experience has shown this to be essential not just immediately post-op but in the weeks and months afterwards so if you *can* obtain one you absolutely should.
  • Large sweatshirt and oversized shorts for surgery day, especially if you wear a bra, as putting clothes on after surgery can be a struggle and it’s easiest to just throw on a sweatshirt and shorts that fit over your post-op bandages and brace.
    • In particular, we found a blanket hoodie to be very useful both for going home and the first few days as it could stay on when moving around/when napping.
  • Neck Pillow
    • Helps with reading or other activities during long hours spent in bed or on the couch and really helped in the first two days to prevent neck strain and provide head positioning during napping.
  • Large pillows for body positioning and elevation of the leg
    • We found cheap, giant, dog beds from places like TJ Max or Marshalls to be more affordable than specialty products
    • A large, thin, dog bed (or blanket) rolled into a tube and secured with stretch bandage or tape around the surgical leg and brace helped significantly with comfort during sleep so that the leg was padded, comfortable, and the other leg didn’t get roughed up from the brace.
  • A shower chair
    • Can be found used at second hand stores like Goodwill, or cheap online
    • Easy substitute is a chair covered in a trash bag
    • Allowed showering the second day post-op which was a huge mental boost and relieved physical discomfort and achy muscles
  • Extra large leg cast cover
    • Can be found cheap online
    • Placed around outside of brace covering the entire leg initially, we then found it easier to place on the leg and place the brace outside of the cover for the remaining healing period for the incisions: We did this after the first PT appointment when it was safe to take off the brace for short periods while laying down. We acquired a second post op brace from a friend (you can find on eBay for cheap) and it was amazing to have, as we could let it dry after showering and immediately put her post op brace back on.
  • Foldable stool
    • Great for elevating the leg during transfers, while on the toilet, etc.
  • Lap Desk
    • Great for eating on the couch or in bed, but we also found it useful as a side table for holding drinks/meds/remotes/books that could be taken to whatever room they landed in at the time
    • A small table works as well, really just anything that can be used to set things on within arms reach
  • Assortment of sodas, water, seltzers, snacks, etc.
    • There is no way to know what you will want and when, but when you want it it’s nice to *have* it available
    • Appetite often decreases after surgery so make sure to have favourites on hand so that when you *are* hungry you have it immediately before your body changes its mind
  • A big bucket
    • We used a soft plastic beach type bucket from the dollar store, it was extremely useful to have to put small items in, a small towel, a spare water bottle, extra meds, baby wipes, etc.
    • Also doubled as an emergency puke bucket, as you never know when a sudden bout of nausea might hit in the first day or two after surgery
  • Extra reusable ice packs and bags of ice
    • Your home ice maker will not be able to keep up with the demands of constant icing the first week or so
    • Reusable ones are great for ‘hot spots’ and short trips where you can’t take the ice machine
  • Extra steri-strips and assortment of bandages
    • Sometimes there’s extra leakage, sometimes your steri-strips come off and you need to slap a new one on, sometimes you’re allergic to the ones they put on you at the hospital. Always consult a medical professional, but it’s handy to have these on hand just in case.
    • We also used a bulky padded bandaid to keep the brace off the healing incisions once the large post-op dressing was taken off which helped immensely.
  • Compression sleeves
    • Aside from helping with swelling these also provided a layer of protection under the post-op brace
    • We found cheap ones at Wal-Mart (copper brand) but also just bought a cheap pair of leggings a size down and cut off one of the legs to use before getting a more expensive one once swelling had fully subsided after a few weeks. Your leg will change so cheap works great at first, then you can get something a bit more substantial when you know what you’ll need long term. Now she wears high compression socks to sleep 3 months out.
  • Slide on shoes
    • Self explanatory, bending down to put on shoes becomes a chore after surgery. Avoid flip flops or other styles that can become a trip hazard.
  • Baby Wipes/Dude Wipes/etc.
    • Wiping down after you get home from surgery can help prevent that icky feeling and restore some sense of normalcy, then can be used over the next few days before you can shower more normally
  • Lotion and chapstick
    • Hospitals dry out your skin big time, and lips are often cracked post surgery from intubation/LMA placement
  • Small, easily labelled tupperware containers
    • Regular pill containers are too small to hold pain meds, OTC pain meds, anticoagulants such as aspirin, supplements, and edibles or other small things you take with your medication. We got small tupperware boxes with lids from the dollar store.
    • We found it very convenient to have six sets of meds set up and labelled with times which meant we never missed doses and could leave the next dose of meds at bedside, take them with us when going to appointments, and keep up with what had been given and when.
  • Small notebook to record med times and other important information
  • Two extra changes of clothes already setup and ready to go
  • Compression device
    • We are athletes so we already had leg compression sleeves but these days off brand versions can be bought online cheap. Studies have shown these lead to reduced pain, increased mobilisation, reduced the chance of blood clots, and there is even some evidence they help with bone healing.
    • We used it 3 days post op and beyond and her range of motion was significantly improved after the first time.
  • A yoga strap
    • Excellent for strapping to the brace and moving the surgical leg
• If possible, pick up post-op medications prior to surgery to prevent any unexpected delay in obtaining them. If this is not possible, verify that the prescription can be filled the day of the surgery by your selected pharmacy and that it has been filled prior to leaving after your surgery. Controlled substances cannot be transferred to another pharmacy without a new prescription sent directly from the provider. You do not want to be trying to get in contact with a physician in the hours after surgery, unable to manage pain, before the pharmacies close for the night.
• Do a thorough clean of your living area, it will make the time after surgery when you cannot independently do normal activities more bearable and a neat organised space is easier to function in when your body is not cooperating. Take special attention to removing tripping hazards and clearing a wide path from wherever you plan to spend your recovery and the bathroom.
• Plan to spend the first couple of days in one spot and on one floor and set up that area the day before surgery. If you have a downstairs bathroom a floor mattress or well setup couch can be your landing pad until you are more mobile and is the easiest during the immediate post-op period. That being said, if you don’t, it’s easier to get upstairs by sliding up on your bum immediately post-op when your pain is still well controlled than realise that you have no bathroom downstairs a few hours later when the pain has started to set in. Wherever you intend to land, plan on staying there at least a couple of days and bring all your supplies to that area. Plan to lay with your surgical leg on the outside of what you are laying on, this makes transferring easier.
• Have your recovery bed setup the day before surgery and prepared for when you return before you leave the day of, including blankets and your supply table setup.
• Meal prep, whether that means cooking or getting easy to make microwave meals is up to you. You won’t feel like cooking and neither will your caretaker the first few days. High protein, easy to eat meals are key! We had chicken and broccoli casserole, egg and sausage frittata, and lots of applesauce the first few days and it was a lifesaver not to have to think about meals.
• Spend some time mentally preparing for the long haul of recovery and make long term plans that fit within your timeline. For example, we planned to attend a rugby game five days after surgery *but* planned nothing else for that day and the next day. We also planned hiking trips the next fall, and other events appropriate for her timeline along the way that could be looked forward to and keep up morale. Remember that this is temporary and that it is okay to be recovering and resting, expect hard moments and days but keep things planned so you don’t get stuck in those down places.
• Eat your favourite meal and eat well the day before surgery. Your body needs fuel to recover and fasting the day of surgery sucks. As weird as it sounds, after multiple surgeries, the pre-surgery night meal of whatever I want is one shiny thing in a crappy situation to hold on to.
• Plan for what you want your first meal to be and consider making a playlist for the ride to and from surgery. Small things, again, help maintain a sense of control and comfort in a situation where you are largely out of control and these things can be done with friends or support people in the days leading up to reduce anxiety and pass time.
• Hit the gym, take a walk, do a hike, visit places or do things you enjoy but won’t be able to do in immediate recovery! We took my partners knee to one last tournament before her surgery, it helped pass time and kept spirits high.

Day Of And Immediate Post-Surgery Phase

• Maintain fasting starting at whatever hour you are told. Some people can drink clear liquids up to a certain point, others are completely nothing by mouth. Your instructions will guide you on this.
• Before leaving home double check that everything is set up how you need it and place a blanket, pillow, drink, and snack of choice in the car. You may or may not need it but if you do it is important to have. Make sure your ice packs are in the freezer ready to go!
• Bring your own post-op snack if you are picky or have food allergies, otherwise you’re stuck with whatever graham cracker and applesauce combo the facility gives you.
• Go with the flow, or as I always say “surrender”. Feel what you feel, have a cry in the car before you go in, listen to your playlist, bring your blanket or other comfort items into pre-op, tell your support person what’s going through your mind, tell your pre-op staff how you’re doing, ask all the questions, and most importantly just do what you have to do. For some people surgery can be overwhelming and the loss of control frightening, but fighting only makes it worse, so whatever you are just be it. I’m pre-op pacer myself, but some people just snuggle up under some warm blankets and wait. Either way, just let the waves take you where they go and know you’re along for the ride. Remember that future you with a healthy joint thanks you for what you’re doing today.
• Speak frankly with your anesthesiologist and utilise any pain control or anxiety control options given to you. There is no award for least meds taken or toughest patient of the day. If a nerve block is available, know that you can request sedation for its placement, and utilise that option if at all possible.
• Caregivers should bring something to keep them entertained and be prepared for a long period without update once surgery has started. Honour your feelings as well, it can be tough to watch someone you care about go through this! Consider having someone to act as a support person for you as well through text or phone, that way you can divert your own worries or struggles to them and away from the person having surgery while still making sure you are also taken care of.
• Make sure that pain is well controlled before leaving after surgery. You have more options there than you will at home and getting things under control once pain has become unbearable can be very difficult.
• Make sure you note when the next dose of medication is due, what medication they should be taking, and write it down.
• Double check contacts from your surgeons office and add any post op paperwork to your folder in case you need the information later.
• If your post-op meal requires picking up, or your prescription, try and do that immediately after leaving surgery even if you are not hungry yet. This is the most comfortable you will be for a while and your support person will be unable to leave for at least that day and night. I have been known to peruse the big gas station after surgery in search of snacks, my partner however simply waved to the nice people at the drive through and napped the rest of the way home before eating some hours later.
• Once you get home crash wherever you plan on spending the rest of the time. Don’t have friends or family over that first day. Just go ahead and sleep through the rest of the anaesthesia and get comfortable.
• Try and keep your home cool, and consider keeping the room dim for the first few hours if not days. Sleep is precious and pain meds can make you hot, and getting hot can lead to nausea. It is better to have the home cool and the person snuggled under blankets and comfortable than be trying to cool someone down who just had surgery and got too hot and is now dizzy, nauseous, and miserable. The least stimulation for the first little while the better, and naps will happen throughout the rest of the day and over the next few days. A cool, dim place lets this happen much easier than a bright, warm place where they might be overstimulated or awakened by noise or activity.
• If allowed, try and activate the quad muscle immediately after returning home and once every few hours by having them squeeze it and feeling for contraction while in the brace. Some people will be able to begin range of motion exercises immediately and if so, make sure to do them as soon as allowed even if that means just helping them by doing gentle manual range of motion movements in the brace.
• If it’s not already on, begin continuous icing as soon as you come out of surgery either by meticulously timing the replacement of ice packs or with the ice machine. Make sure to check the ice machine, replace ice as often as needed, and keep it on *continuously* for the next few days. For us this meant I checked it at every medication dose throughout the night and added ice during that time as well. We went through frozen mini water bottles and bags of ice like crazy the first week.
• Elevate the surgical leg as high as possible, placing support under the heel and calf but not directly under the knee to promote extension and prevent more headaches with gaining range of motion later on.
  • We found that icepacks directly under the knee helped tremendously with the discomfort associated with this.
• Anticipate that bathroom trips will not be fun or easy and take them extremely slow. As a caregiver allow the person to guide you on what they need and don’t need your help with and avoid grabbing or moving someone unexpectedly. Standing, acclimating to being upright, and then proceeding to the bathroom is the best way to do things and rushing will only result in frustration for both of you. A rolling chair or wheelchair can be helpful, but for some people standing up and sitting down is harder than just moving on to the bathroom. Pay attention as a caregiver and know that it is possible they may need your help getting off the toilet or back from the bathroom so be close by and available should that happen. For the first few days do not lock the bathroom door in case of an emergency.
• Place chairs or things to sit on around your path to the bathroom, kitchen, etc. And consider a small backpack or using a rolling chair to carry items around the house.
• Once you know when your next dose is, set alarms for each time your doses are due. If using the med boxes this makes doing meds and keeping track very easy, as they are each labelled with a time and all we had to do was open the box and take the meds instead of finding each bottle and dosing each med individually each time. As the days went on we were able to re-label and time the boxes as needed and remove meds as needed or adapt to what was needed when sleeping or up during the day.
  • For example day 1 would look like:
    • First post-op doses at 4pm box: 250mg tylenol, 10mg oxycodone, 5mg edible.
    • 8pm box: 250mg tylenol, 10mg oxycodone, 800mg ibuprofen, 10mg edible, 12.5mg diphenhydramine (itching and sleep), stool softener, and regular night time meds.
    • Midnight box: 250mg tylenol, 5mg oxycodone, 5mg edible.
    • 4AM: 250mg tylenol, 5mg oxycodone, 800mg ibuprofen, edible (if nauseas or restless).
    • 8AM box (preparing to get up): 250mg tylenol, 10mg oxycodone, 5mg edible, aspirin, stool softener, normal morning meds.
    • 12pm: 250mg tylenol, 10mg oxycodone, 5mg edible, 800mg ibuprofen.
    • Repeated on time, reducing pain med dose as tolerable, and refilling boxes 1x a day.
• If possible do scheduled tylenol (paracetamol) and ibuprofen (or another NSAID), alternating them on the dosing schedule, and take them religiously even through the night. This also goes for additional pain medications, which you will also need to wake to take through the night if you are prescribed for at least the first night.
• Staying on schedule might mean waking up in the night, but it’s better to be awoken to take meds than to wake up in pain and spend several hours trying to get it under control. You may find you seldom need them if your nerve block is in place, or you may just not need very much at all during your recovery. It is easier to trial run this after the first day by stretching out the time between doses from 4 to 6 to 8 and then potentially off entirely, but everyone will have their preferences.
• Eat a small snack with every med dose and keep emergency meds (extra pain med doses, nausea meds, etc.) at bedside as well as the next set of meds due so they can be taken when it is time.
• We found that edibles were a great addition to pain and nausea control after surgery. There are medication options available and having at least one option for nausea is advisable for the first few days after surgery when anaesthesia and medication can really make you want to puke.
• Expect absolutely nothing in the first few days post-op. Some people will feel well enough to move around, others will not be able to do anything but get up to use the bathroom. Expecting nothing is better than expecting more and being disappointed or frustrated. I would highly suggest not making plans until your first follow up 7 or so days after surgery.
• Be obsessive about icing, meds, any PT you have been given, and keeping track of appointments. Give yourself the best start to your recovery that you can and you will thank yourself later!

I’ve seen primary care doctors and can’t get to a specialist because I guess they don’t take me seriously.
A little over a month ago I cleaned up dust from a floor refinishing. The company had already finished the floors and sealed the floors. I was wiping up dust with wet rags on horizontal surfaces.
My sinuses have been super dry and messed up since. Not like allergies, I have had those before, like the texture has been removed from the inside of sinus and the snot I produce is more or less just water. I’ve had stints where it gets a little better for a few hours but never normal. One side hurts and if I flex my face I can feel pulling and stinging inside the nasal cavity. I tried to go back into the house but symptoms come firing back, irritated eyes, sinuses lock up worse than before it’s awful. Also it makes my mouth taste weird , eyes burn and my throat itch.
I have since learned much about wood dust. All the information I can find is on occupational exposure. It was dusty but it didn’t seem like a crazy amount. Didn’t wear a mask. The wood was walnut and apparently that has its own issues, (irritant, sensitizer, cancers) but can’t find an expert on that either.
Male 6’4” 245 lbs , 120/81, 60 bpm , 44 yrs old
I’m frustrated, not being able to breathe right is making me crazy. I was sent home with antihistamines that just dried my sinuses out worse. I’ve been using nasal rinses and moisturizing gels. Other people have been in the property and say they don’t notice anything. Idk what specialist to ask for or what tests to run. I can hardly find anyone that’s had close to the same experience. No idea if this will ever get better.

*I will of course talk to my dr about this, just curious if anyone else has this going on. :) *
Going on 21 years with MS, lots of spinal damage, and recently having more issues with autonomic disfunction.
For years I’ve had “coughing fits” where something will barely irritate my throat, like juice from a pickle or just a tickle, and I will start coughing and coughing. It’s a dry cough, but I can’t stop. I can breathe, but it definitely feels like my throat is constricted. In one particular attack I was having stridor breathing. Sometimes taking a drink will stop it, sometimes I have to blow my nose, sometimes I have even thrown up.
It’s one of those things that started out as no big deal and has gradually gotten worse. I first thought maybe it was a reaction to irritants, like acidic things, but now it seems more random.
Anyone else have issues like this related to MS? Specifically those with spinal lesions and autonomic dysfunction.

The most recent success story post made here a couple days ago gave me tons of hope. It made a lot of sense and the symptoms mostly align with mine! I tackled all of my gut issues. My bowel movements are healthy and regular. I’m eating all the right foods and I’m not experiencing and discomfort relating to indigestion or acid reflux.
So, at this point I know it’s an overgrowth of bacteria in my mouth. It has to be. If this happens to not work I’m going to schedule something to get my tonsils and wisdom teeth removed. That’ll most likely be my last resort!
Wish me luck! And I will update you guys on the results.
I live in the US. The place I’m getting this procedure/diagnosis/cleaning done is called Vibrant Dentistry and they specialize in deeper rooted issues with oral health.
My symptoms:
(For a year now)
-Horrible morning breath
-Dry mouth resulting in a uncomfortable taste in my mouth
-Bad breath throughout the day
-In and out of sickness (sinus and throat)

I wake up with headache or pressure in my head every single day since 3 years. It gets better after getting up.
Literally woke up with it one day and it hasn't gone away since. I was originally diagnosed with NDPH (New Daily Persistent Headache), but I'm not buying it.
In addition to the headache, I suffer from:

• Bruxism
• Stuffed nose
• Dry throat in morning
• Brain fog, harder to find words
• Feeling like crying despite feeling ok
• Light flu-like symptoms like 'tingly' ears
• Not feeling like the sleep was restorative
• Tired, sensitive, wrinkly & blood-shot eyes
• Periods of unquenchable thirst and dry lips

Main symptoms (pressure in head) are ALWAYS worse in the morning and during the night, and seem to alleviate temporarily when I eat.
I have a history of jaw surgery for my overbite, which is still somewhat there.
I am suspecting a possible sinus condition as well as most, if not all of my symptoms are in or around my head.
Could I have TMJD? Ainyone here who is in the same boat?

24M, 6'1, 200mg Lamictal, Occasional Cigarette smoker So about 12 days ago I woke up with what felt like a bruised/swollen bottom right lip. Not any tingling, just felt tender. Over the next few days, the swelling went down except for in more isolated spots still on the bottom of the right lip that felt like small bumps (near the border but I think on the lip). there hasn't really been any pain, only annoyance from licking the spot and really drying the skin. Then about 9 days in a couple of white heads similar to the one in the picture popped up and rose to the surface very quickly. I popped them and a tiny bit of white pimple-like fluid came out. Now another tiny white head popped up and the skin is just extremely dry. Everyone I've asked to look at it doesn't think it is/was a cold sore but I cant figure out what else it could be. Thoughts?
Sorry for the shitty picture!

On May first I had drawing sinuses, back of mouth raw. Thought it was a cold or allergies. For the last few days I had been around only two people. Sure enough it was Covid and wrote to the two people and one was positive. Felt crappy for four days, chills in evening, sinus pressure, headache…and the mucous. I did start Paxlovid day 4. Felt better when I was off that five day dose, still some congestion and a dry cough. Tested negative on day 10. Got to feeling pretty good there for a week. Probably did too much. Saturday night, day 18: developed a cold sore. Sunday I was just tired. Nap didn’t help. Couldn’t get it going. Yesterday and today I have a dryish cough, sinus things seem to be simmering. Blood pressure is higher than normal and this is concerning. Just don’t feel good again.
Does this sound familiar to anyone else? Trying to get into doctor, but they are booked. If anything, thanks for listening.

Hi neighbors.
Just moved here a month ago in north creek area.
(Thank you to those with advice given so far on new AC unit. Still researching that and seeing what cost effective solutions I can find.)
Been watching up with dry throat and bloody mucus in nose. Researching symptoms come down to dry air. Not sure if it’s my ac unit creating this environment or maybe this new area in north creek Leander we live in now. Wondering if anyone else has experienced the same symptoms.
Thank you. 🙏🏽

M32 here, generally healthy with no smoking and very minor drinking just on special occasions.
https://imgur.com/a/dwHT5zu
Recently have had pain swallowing for 13 days. Swallowing food and drink is fine, but when just swallowing saliva I feel throat pain.
Also feel the need to cough a dry cough every 5 minutes or so. Every time I cough the right side of my throat has a sharp quick pain. Have had this symptom about 5 days.
Another symptom is the right side of my neck has a constant, almost warm-feeling, dull ache. Feels like a muscle pull but going to mention as in the same area as the rest and I can't consciously remember pulling it.
Finally, I've just been checking my throat and mouth and noticed three things under my tongue; being the dark red mark, the lighter red on the underside of the tongue and the swollen lingual frenulum.
Based on the above, could you please let me know if these symptoms point to anything and whether they should have me worried.
Thank you.

Im 8dpo (31F lap turned abdominal. Kept ovaries and cervix) and i think im past the worst of it. While im still pretty much couch ridden, I figured I would put this out there to maybe help someone else preparing for their surgery! Obviously we all know these experiences are highly personal and will not be exactly like anyone elses experience, but I personally found it helpful gathering peoples experiences and reflecting based on what I know about myself so I thought id write the kind of post Id want to read! I tried to make easy to skim but also included plenty of details!
Heres some things Im glad I did beforehand

• washed and changed my bed sheets -cleaned my bathroom well
• moved things i knew i would need to a hight where I don’t have to bend down to get them. I moved my toilet paper to easy accessible places, my pj shirts and underwear on top of my dresser. Set up a bed stand for water and meds. Also moved my fridge around.
• as for buying stuff, i mostly had everything i needed but was glad to have comfy sweat pants, backless slippers and highwasted underwear. Also those rechargeable battery bricks were handy for charging my phone in the hospital or sitting somewhere not near an outlet. -exercised. Dont stress about this one, i know chronic pain is often the reason for this surgery. I had to stop my routine months before surgery for this reason. But I was glad to be familiar with proper squat form and have strong arms and legs to help get myself up and down without using my core. I also did yoga therapy that helped me understand how to transfer my weight to different parts of my body which helped too!

Heres some things i was extremely stressed about but ended up not being a problem
-Food. My mom came and cooked me some large portion of meals. I ended up throwing most of it away. The idea was to freeze some of it but it was too much of a hassle. I didn’t have much of an appetite and definitely gravitated towards things in the BRAT diet especially bread. I spent the first few days eating like i had the flu and was really sensitive to grease. My mom made wedding soup and it was too greasy. I think i could have survived this week just on a package of bagels and different spreads.
-cleaning and chores. Im pretty sure I have OCD.. this experience has confirmed it. I looked out at my thriving garden yesterday and said to my partner absent mindedly “wow. Things really thrive when im not out there being over involved “ and like wow that is a lesson i did not expect to learn. My partner has been clearing the dishes each day and did some more involved chores once this week. So if you live alone I would advise paper plates and maybe some to help ya once a week for the first week at least.
-in terms of my surgery i was really scared of having a catheter which i did end up needing to have for a day. It was weird but not at all painful. Honestly it was kind of the worst part of my recovery so far just because i felt i had to pee so bad while it was in. Idk if thats typical. Taking it out was not at all painful but also weird. They used the catheter to put sterile water back in my bladder. As soon as i felt a twinge of uncomfortable full feeling i told my nurse. She removed the catheter and i peed it back out no problem.
-being bored. This week has felt like one day. Since it takes me 10x as long to do anything, the days are flying by. I got myself plenty of low key things to do (crafts, activity books, ect) and haven’t even had time to do any of them yet! I still have a feeling this will change in the coming weeks though..
-having enough help. I secretly wished one of my friends or family members would stay with me for a while just so I could be the solo focus of their attention. I live with my partner and two dogs and he has been totally enough support. I needed help getting up and down up until about day 5. He also makes my meals and cleans them up for me and would bring me my meds and water the first few days. I think it makes sense if you live alone to have someone stay a week with you, but ive been fine and honestly anytime someone has come to “help” its just felt draining. I didn’t know how much of a hermit I would wana be.
-my dogs. I piled myself in pillows if i was sitting on the couch with them. I also had a no chew spray near by that we used when they were pups but only had to use it one time. My partner helped to coral them the first few days too. I have not yet been puppy stomped
-the stairs. Its been fine I just have to go slow.
Heres some things I found out along the way that were helpful

• keep cough drops in your pocket. Coughing aint fun and my throat was irritated from being intubated for about 4 days after surgery. Also keep the paper so you can spit em out when they’ve done the job if you want. I started getting a tummy ache from having too many.

-keep lil pillows by your toilet. The hospital gave me one that was plasticy and easy to wipe off (like an outdoor pillow insert). Or even a balled up towel would work. I couldn’t wear a binder because of all my incisions but this helped take the pressure off my stomach/incisions when i needed to have a bowel movement.
-if you stack pillows on either side of you, they can act as “arms” that are handy to push down on when you get up.
-sip your water and take your stool softeners as soon as they say you can! It took me until day 4 to poop but it was no problem when it happened.
-lots of deep slow breaths to calm your nerves and pain.

• those squeezable applesauce packs. Great for when you take your pain pills.

Heres some challenges I encountered that surprised me.
-my throat was so sore! For the first 4 days my throat was irritating, it felt like I had a flap of skin sticking down. The first day it hurt but the rest was just so annoying.

• breathing was a challenge. The first few days i was in bed, it was hard to breathe. I couldn’t take a Deep belly breath because of my incisions. I tried to regularly take a big breath filling my lungs though. Once i started being able to get up and walk around it became less of a problem. I think they have a tool for this at the hospital too but i was not offered it and forgot to ask.

-always laying on my back is getting old. I haven’t quite figured it out yet but im getting there.
-not really a challenge but my lower belly is numb. Apparently that can just happen (even long term). Which has actually been helpful since I can’t feel my lower abdominal incision at all
Lastly!! The pain/symptom scale: Day 0: honestly don’t remember much except feeling i need to pee and my throat being sore. Day 1: was still in the hospital. Pain like cramps and burning pain near certain incisions. I was able to walk the hall but very tired after. Sore throat. Day 2: burning pain near bellybutton incisions. Heavy lung feeling. Left the hospital. Day 3: heavy lung feeling. Pinching pain in incisions whenever I stood or sat. Had some moderate discharge that was yellowish with red and brown. Otherwise no pain Day 4: more like a sharp ache when i stood/sat. Discharge again but a very light amount. Day 5: felt strides..any pain was mild cramping. Tried to shower myself and make myself breakfast which led me to be very tired for the rest of the day. Day 6: most tired yet. Pain the same Day 7: felt like turning a page. Pain very little and energy very good.

20F 5’8/140 lbs
i have already been to the doctor but my symptoms are not going away. i keep telling myself that it’s just anxiety but there’s certain things that i am having a really hard time just ignoring
i will try to keep this as concise as possible given the amount of context involved. about five years ago i was forcefully choked by an ex boyfriend. with his hand on my throat, he suddenly pressed down with considerable force i remember feeling/hearing a “pop” followed by swelling for the rest of the night. i woke up and felt fine other than tightness in my neck that came and went for a few months. i have had pain on the right side of my neck (where his thumb was) on and off since then
about a month ago (and i feel stupid for this) my boyfriend was (consensually) choking me during sex and we may have accidentally gone too far. i woke up the next morning with petechiae on both sides of my face on my cheekbones and under my jaw
it has been about a month and i have experienced the following symptoms that come and go depending on the day; some days i feel fine, others i experience symptoms that are so persistent i become concerned:
——- enlarged pupils, especially towards end of the day
localized 3/10 pain at impacted area (right side of neck under jaw)
sometimes feel lightheaded and considerable pressure in my head when standing up, can also “hear” or feel my heartbeat when this happens
general weakness
small black spot that flashes for a millisecond in the same area of my vision (this started only a couple of days ago and has happened >5 times)
vision feels “off,” not quite blurred/double vision but almost like my eyes have a hard time focusing or my brain has a hard time interpreting what i’m seeing
persistent pressure behind right eye
slight difficulty with speech (feels effortful to enunciate/find words, but ever so slightly and unnoticeable to others)
occasional tinnitus (lasts anywhere from 5 sec-5 min)
occasional dizziness
sharp chest pain on left, next day dull ache on right that extended to my shoulder and arm ——-
i am very concerned about carotid artery dissection given my history of trauma to that area. i have been to urgent care as well as my general practitioner to receive a physical examination for this issue and both told me that my vitals were normal and that i should be fine. i specifically mentioned carotid dissection with my GP and she said she wouldn’t recommend imaging as it was likely unnecessary and would be difficult to get covered by insurance. however, it has been a month since this happened and there are days when my symptoms are bad to the point where i really can’t ignore them. i know i can have health anxiety at times, but the fact that i will feel completely fine and not anxious and then feel physical symptoms out of nowhere is what concerns me
could there be another explanation for my symptoms? should i go to the ER and eat the cost of imaging? also, my BIGGEST question is: if i had carotid artery dissection in my neck, would my BP be abnormal? both times i was examined, the doctor told me that my BP was normal so i should be fine. is this true? or could the dissection be minor and affecting blood flow to my brain but not my BP? since it’s been a month, when will i know that i’m in the clear and not at risk of having a stroke? i am doing everything i can to convince myself that my doctors are right and that imaging is unnecessary, but these persistent symptoms are driving me insane with worry

DAY: MAY 20 2024
5-20-2024

Why nightmares and ‘daymares’ could be early warning signs of autoimmune disease

An increase in nightmares and hallucinations—or ‘daymares’—could herald the onset of autoimmune diseases such as lupus, say an international team led by researchers at the University of Cambridge and King’s College London. The researchers argue that there must be greater recognition that these types of mental health and neurological symptoms can act as an early warning sign that an individual is approaching a “flare,” where their disease worsens for a period.
5-20-2024 Yoga and meditation-induced altered states of consciousness are common in the general population, study says
Yoga, mindfulness, meditation, breathwork, and other practices are gaining in popularity due to their potential to improve health and well-being. The effects of these practices are mostly positive and occasionally transformational, yet they are known to sometimes be associated with challenging altered states of consciousness. New research by a team including investigators from Massachusetts General Hospital reveals that altered states of consciousness associated with meditation practice are far more common than expected. Although many people reported positive outcomes, that were sometimes even considered transformational, from these experiences, for a substantial
5-20-2024 Examining the benefits of out-of-network care for pediatric moyamoya
Total in-episode expenses and resource use before the index surgery (preop) and including/after the surgery (postop). The comparisons are separated for analysis into (A) single institution cohorts (1 and 2) and (B) multi?institution cohorts (3 and 4). Moyamoya disease is a rare condition that affects the blood vessels in the brain, especially in children. Narrowing and blockage of vessels significantly increases the risk of stroke and requires surgical revascularization for treatment. Although research shows that outcomes of revascularization are better
5-20-2024 Study explores links between social media use, mental health and sleep quality
The more time you spend on social media, the greater the likelihood of having unpleasant social-media related dreams that cause distress, sleep disruption and impact our peace of mind. Flinders University’s Reza Shabahang says that the vast and rapid adoption of social media has the potential to influence various aspects of life, including the realm of dreaming. “As social media becomes increasingly intertwined with our lives, its impact extends beyond waking hours, and may influence our dreams,”
5-20-2024 How are asthma and heart health linked?
Although the heart and lungs are neighbors in your chest, people may think of them as separate entities with unrelated problems. But a growing body of evidence suggests that asthma—one of the most common lung disorders—is a risk factor for cardiovascular disease. Asthma is a serious chronic disease in which airways are inflamed, often in response to specific triggers. It affects about 25 million people in the U.S., including nearly 5 million children, causing millions of annual visits to doctors’ offices and emergency rooms. “We call these major changes
5-20-2024 STUDY EXPLORES PATIENT TRUST IN PHYSICIANS
Trust in one’s physician drives positive health practices. In a scoping review, SUNY Poly Professor of Sociology Dr. Linda R. Weber discovered new developments in the measurement of trust, identified those measures of trust that have known reliability and validity, and compared those instruments’ conceptualizations, dimensions, and indicators. The paper is published in the journal PLOS ONE. Weber explains that 10 dimensions emerged from the study: fidelity, technical competence, communicative competence, interpersonal competence (i.e., caring), honesty, confidentiality, global, behavioral, fairness, and system trust/accountability. In addition, these findings provide the foundation
5-20-2024 TIMESAVING TIPS FOR COOKING HEALTHY MEALS
Living a busy, fast-paced life can make it hard to find the motivation to cook a healthy meal at home. However, learning some shortcuts in the kitchen can keep your healthy eating goals on track and help you avoid grazing on unhealthy snacks, grabbing the first thing you see in the fridge or going out for fast food. Why cook at home? Research shows that maintaining a healthy weight is challenging when you eat out too frequently. Restaurant portions often are super-sized
5-20-2024 UNDERSTANDING PERIMENOPAUSE VS. MENOPAUSE
Menopause marks a significant transition for women, yet understanding its precursor, perimenopause, and its symptoms can be complex. Dr. Stephanie Faubion, director of Mayo Clinic’s Center for Women’s Health and medical director of The Menopause Society, says experiencing perimenopause and menopause can be confusing for some. She says it is not only patients who may find it confusing, but medical providers as well, due to lack of training in menopause management. “Menopause is defined by no menstrual cycle for a year,” says Dr. Faubion.
5-20-2024 LOW-DOSE IRON SUPPLEMENTATION HAS NO BENEFIT FOR BREASTFED INFANTS, SHOWS STUDY
The American Pediatric Association recommends iron supplements to all healthy infants who breastfeed longer than four months, while its European counterpart, Society of Gastroenterology, Hepataology and Nutrition, does not recommend it. These deviating guidelines stimulated researchers to design a new study. Breastfeeding is strongly recommended, and the proportion of children are breastfed during the first half of life is high. The researchers wanted to determine whether breastfeeding babies could benefit from extra iron.
5-20-2024 ALLERGY MEDICATIONS COME WITH HAZARDS: BE AWARE
People with seasonal allergies often turn to over-the-counter and prescription medicines to relieve symptoms like coughing, sneezing, runny nose, congestion and itchy eyes, nose or throat. But they often aren’t aware that these meds—including antihistamines—have as much risk for potential side effects, drug interactions and overdose as other drugs. “All medicines have side effects associated with them even when they are taken appropriately and according to dosing directions on the label,”
5-20-2024 I CAN’T AFFORD OLIVE OIL—WHAT ELSE CAN I USE?
If you buy your olive oil in bulk, you’ve likely been in for a shock in recent weeks. Major supermarkets have been selling olive oil for up to A$65 for a four-liter tin, and up to $26 for a 750 milliliter bottle. We’ve been hearing about the health benefits of olive oil for years. And many of us are adding it to salads, or baking and frying with it. But during a cost-of-living crisis, these high prices can put olive oil out of reach. Let’s take a look at why
5-20-2024 Researchers uncover biological trigger of early puberty
Heather Brenhouse, associate professor of psychology, says disrupting the caretaker relationship can really traumatize a child or a developing rodent. Credit: Ruby Wallau/Northeastern University New research conducted by the Brenhouse Lab reveals how early life adversity triggers early puberty and late-life anxiety, paving the way for potential interventions. The onset of puberty has been creeping downward for decades. In the United States, the average age of girls reaching puberty ranges from 8.8 to 10.3 years old. The early start of puberty, which is associated with many health risks, can be
5-20-2024 Bioluminescence and 3D-printed implants shed light on brain–spinal interactions
Brain-spinal cord duet’s neurodynamic symphony is now accessible to scientists via novel multi-organ implants. Credit: Dmitrijs Celinskis A sensory process such as pain is no ordinary phenomenon—it’s a symphony of neural and vascular interactions orchestrated by the brain and spinal cord. Attempting to dissect this symphony by focusing on a single region is like trying to understand a complex melody by listening to just one instrument. It’s incomplete, potentially misleading, and may result in erroneous conclusions. Enter the Carney Institute’s team of visionaries. Their mission? To develop tools that allow
5-20-2024 New thesis explores cancer treatment that can prevent relapse
. What is the main focus of your thesis? Relapse following initial treatment efficacy remains a major clinical challenge for many cancers. The focus of my thesis has been to explore the therapeutic impact of immune cells in patients with blood cancer (leukemia), by first investigating which cells
5-20-2024 New study reveals health and social benefits of car-free living
Participating in a three-week car-free challenge has enhanced the health and well-being of Oxford residents, according to research conducted by The University of Bath’s Centre for Climate Change and Social Transformations (CAST), in partnership with climate charity Possible and Low Carbon Oxford North (LCON), conducted this research project. After ditching their cars for three weeks, 10 out of the 12 drivers across Oxford who participated said they plan to continue with reduced car use beyond the project. The findings of this research project show that: Day-to-day transport emissions were slashed
5-20-2024 Research shows linked biological pathways driving skin inflammation
A certain biological pathway—a set of linked reactions in the body—drives the inflammation seen in the skin disease psoriasis, a new study finds. The work could lead to improved therapies for all inflammatory skin diseases, including atopic and allergic dermatitis and a type of boil called hidradenitis suppurativa, say the study authors. The findings are published in the journal Immunity. Inflammation is the body’s natural response to irritation and infection, but when out of control, it can lead to the reddish, flaky, itchy lesions that
5-20-2024 Prescription co-payments linked to more hospital admissions in New Zealand, study finds
A new study from researchers cautions that bringing back the $5 co-payment for prescription medicines could see a jump in hospital admissions. The study analyzed health data for 71,502 people and found those who didn’t pick up a prescription because they couldn’t afford the $5 fee had a 34% higher rate of being admitted to hospital.
5-20-2024 How a simulation is informing COVID-19 vaccine policy after our ‘return to normal’
As the saying goes “There is no such thing as normal” and this has been especially true after the pandemic. Before the emergence of the omicron COVID-19 variant, countries like the U.K. had high vaccination coverage along with widespread exposure to COVID-19 in the population. This combination of vaccine and infection-derived immunity is termed hybrid immunity and is different to vaccine immunity or infection immunity alone. In contrast, other countries, including Australia, New Zealand and those in the Western Pacific, had a very different pandemic experience.
5-20-2024 Researchers find intriguing connections between Alzheimer’s disease and other common conditions
A study has found that while some medical conditions appear to increase our likelihood of developing Alzheimer’s disease, others appear to decrease the odds. The study, led by Dr. Yijun (Nicholas) Pan and Dr. Liang Jin, analyzed data from 2,443 older Australians living in Melbourne or Perth who are part of the Australian Imaging, Biomarker and Lifestyle (AIBL) study, an internationally recognized cohort for dementia research. “We found anxiety and other neurological disorders are associated with increased likelihood of Alzheimer’s disease,” Dr. Pan said.
5-20-2024 Prepping autistic or sound-sensitive kids for cicada noise
As Chicagoans await the emergence of the cicadas, parents of children on the autism spectrum and/or who have sensitivities to sound can take a few steps to prepare for what is expected to be a loud summer. “Some children on the spectrum can struggle with loud or unexpected noises, such as toilets that automatically flush, fireworks around the Fourth of July or the emergence of a large number of cicadas,”
5-20-2024 Study highlights importance of screening for rare inherited iron metabolism defects
Over 40% of cases curated based on stringent clinical and laboratory criteria from the Indian subcontinent have an inherited iron metabolism defect on comprehensive genomic evaluation, report investigators in The Journal of Molecular Diagnostics. Although iron deficiency anemia is the most prevalent form of anemia globally,
5-20-2024 Study finds tyrosine kinase Csk promotes germinal center B cell survival and affinity maturation
The authors found that Csk (a tyrosine kinase that attenuates B cell receptor signaling) is required for germinal center maintenance and efficient antibody maturation. The immune system strikes a fine balance by identifying and neutralizing disease-causing agents while carefully avoiding destruction of healthy tissues and cells. Now, researchers from Japan have shed new light on one of the processes that helps train immune cells to act only against genuine threats.
5-20-2024 Significant gaps between science of obesity and the care patients receive, say experts
As research continues to produce evidence about the underlying causes of obesity and optimal strategies to treat and manage obesity have evolved, there are disparities in application of the latest scientific advances in the clinical care that people with obesity receive. Widespread adoption of current findings, consistency of care and expertise in obesity care varies by health care professional and institution.
5-20-2024 Improving online depression treatment
Symptom course of depression for individuals who dropped out of treatment and those who completed treatment. In the dropout group, there is an initial decrease in symptoms while the patients were still in treatment, which tapers off as they drop out. For completers, there is close to a linear change over time. This suggests there is a relation between the more that an individual continues to participate in ICBT and their depressive symptom improvement.
5-20-2024 Women face worse chronic kidney disease management in primary care
Women receive worse primary care-based chronic kidney disease (CKD) management than men, according to a research letter adult patients with CKD receiving primary care at 15 practices using electronic health record data to examine sex disparities in guideline-based CKD management
5-20-2024 Bisoprolol does not reduce exacerbations in at-risk COPD patients
For patients with chronic obstructive pulmonary disease (COPD), bisoprolol does not reduce the number of self-reported exacerbations treated with oral corticosteroids, antibiotics, or both, according to a study
5-20-2024 Anticancer potential of CLK kinase inhibitors 1C8 and GPS167 via EMT and antiviral immune response
The diheteroarylamide-based compound 1C8 and the aminothiazole carboxamide-related compound GPS167 inhibit the CLK kinases, and affect the proliferation of a broad range of cancer cell lines. A chemogenomic screen previously performed with GPS167 revealed that the depletion of components associated with mitotic spindle assembly altered
5-20-2024 Study sheds light on bacteria associated with pre-term birth
Researchers from North Carolina State University have found that multiple species of Gardnerella, bacteria sometimes associated with bacterial vaginosis (BV) and pre-term birth, can coexist in the same vaginal microbiome. The findings, published in mSystems, add to the emerging picture of Gardnerella’s effects on human health. Gardnerella is a group of anaerobic bacteria that are commonly found in the vaginal microbiome. Higher levels of the bacteria are a signature of BV and associated with higher risk of pre-term birth, but it is also found in women who have no sign
5-20-2024 New AI model uses federated learning for multi-organ segmentation based on medical image data
Researchers have successfully developed the technology that can accurately segment different body organs by effectively learning medical image data used for different purposes in different hospitals, which is expected to greatly contribute to the development of large-scale medical AI models in the future.
5-20-2024 Second Phase 3 clinical trial again shows dupilumab lessens disease in COPD patients with type 2 inflammation
Chronic obstructive pulmonary disease patients with type 2 inflammation may soon gain access to a new drug—dupilumab—that showed rapid and sustained improvements in patients in a pivotal Phase 3 clinical trial, researchers report in the New England Journal of Medicine. This monoclonal antibody is the first biologic shown to improve clinical outcomes in COPD. The data supporting the use of dupilumab in COPD will be reviewed by the United States Food and Drug Administration in June. The disease improvements—as measured by a significantly lower annualized rate of acute exacerbations
5-20-2024 New AI model uses federated learning for multi-organ segmentation based on medical image data
Researchers have successfully developed the technology that can accurately segment different body organs by effectively learning medical image data used for different purposes in different hospitals, which is expected to greatly contribute to the development of large-scale medical AI models in the future.
5-20-2024 Second Phase 3 clinical trial again shows dupilumab lessens disease in COPD patients with type 2 inflammation
Chronic obstructive pulmonary disease patients with type 2 inflammation may soon gain access to a new drug—dupilumab—that showed rapid and sustained improvements in patients in a pivotal Phase 3 clinical trial, researchers report in the New England Journal of Medicine. This monoclonal antibody is the first biologic shown to improve clinical outcomes in COPD. The data supporting the use of dupilumab in COPD will be reviewed by the United States Food and Drug Administration in June. The disease improvements—as measured by a significantly lower annualized rate of acute exacerbations

• 5-20-2024GALLBLADDER CANCER RISES AMONG BLACK AMERICANS AS CASES DECLINE IN OTHER GROUPS
• 5-20-2024US PEDIATRICIANS REVERSE DECADES-OLD ADVICE AGAINST HIV-POSITIVE MOTHERS BREASTFEEDING
• 5-20-2024UK REPORT FINDS COVER-UP OF DECADES-LONG INFECTED BLOOD SCANDAL
• 5-20-2024ASTRAZENECA TO BUILD $1.5 BLN CANCER DRUG FACILITY IN SINGAPORE
• 5-20-2024CHEMO FOR GLIOBLASTOMA ENHANCED BY TAPPING INTO CELL’S DAILY RHYTHMS
• 5-20-2024RESEARCH SHOWS THAT FERROPTOSIS, A FORM OF CELL DEATH, OCCURS IN SEVERE COVID-19 PATIENT LUNGS
• 5-20-2024BODY’S ‘MESSAGE IN A BOTTLE’ DELIVERS TARGETED CANCER TREATMENT
• 5-20-2024EARLY BLOOD GLUCOSE CONTROL FOR THOSE WITH TYPE 2 DIABETES CRUCIAL FOR REDUCING COMPLICATIONS, PROLONGING LIFE
• 5-20-2024GRID CELL RESPONSES TO THE ILLUSION OF SELF-LOCATION
• 5-20-2024RESEARCHERS DISCOVER TOP-DOWN SIGNALS IN BRAIN CIRCUITS REGULATING DEPRESSION
• 5-20-2024BENIGN NAIL CONDITION LINKED TO RARE SYNDROME THAT GREATLY INCREASES CANCER RISK
• 5-20-2024RESEARCHERS REVEAL PROMISING TREATMENT TARGET FOR RESISTANT BRAIN CANCER
• 5-20-2024NEW MECHANISMS UNDERLYING TUMOR VARIETY IN BRAIN CANCERS DISCOVERED
• 5-20-2024STUDY EXPLORES PATIENT TRUST IN PHYSICIANS
• 5-20-2024MOTIVATED BY LACK OF DIVERSITY IN NEUROLOGICAL STUDIES, SCIENTISTS LOOK TO ENSURE EQUITY IN BRAIN RESEARCH
• 5-20-2024FLUORIDE EXPOSURE DURING PREGNANCY LINKED TO INCREASED RISK OF CHILDHOOD NEUROBEHAVIORAL PROBLEMS, STUDY FINDS
• 5-20-2024STUDY SUGGESTS BOTH STEP AND TIME-BASED EXERCISE TARGETS ARE EQUALLY BENEFICIAL
• 5-20-2024MEDICAID ‘UNWINDING’ DECRIED AS BIASED AGAINST DISABLED PEOPLE
• 5-20-2024TIMESAVING TIPS FOR COOKING HEALTHY MEALS
• 5-20-2024UNDERSTANDING PERIMENOPAUSE VS. MENOPAUSE
• 5-20-2024LOW-DOSE IRON SUPPLEMENTATION HAS NO BENEFIT FOR BREASTFED INFANTS, SHOWS STUDY
• 5-20-2024IS IT BIRD FLU JUST AN ANIMAL THING, OR CAN PEOPLE CATCH IT?
• 5-20-2024SCIENTISTS USE NEW APPROACH TO DISABLE BRAIN CANCER CELLS’ ABILITY TO SURVIVE
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“Mercy would want Malice to ascend rather than endangering others.” When Charity didn’t react, he pushed harder. “Apologies, but you have to know it’s true. Mercy would never allow the Dreadgods to keep killing people when it’s possible to remove them.” Charity’s eyes widened. Just slightly, but Dross made sure Lindon couldn’t miss it. And Lindon interpreted the sudden shock and horror that cracked the mask. Dross gasped in delight when he recognized what Charity’s expression meant, and pressure tightened around Lindon’s throat. Malice had made him swear not to reveal the truth “to the uninformed.” The intention was more important than the phrasing, but Lindon had known what she meant. His own intent was clear. He wouldn’t reveal the connection between the Monarchs and the Dreadgods to anyone he wasn’t certain already knew. And he had been certain that Charity did. Malice had told him already that she told Sages and Heralds. How would she not have told her own granddaughter? Dross calmed down from his uproarious laughter to speak, [Aaahhhh, but that’s not what she said! She tells Sages and Heralds that have a good chance of advancement, or that get close to the truth on their own. Charity has never tried to advance to Monarch. She’s never wanted to. And now…we get to see what’s on the other end of total spiritual collapse!] The world was darkening around Lindon. His madra channels hurt worse than they ever had since he’d absorbed the Diamond Veins. His spirit was twisting itself in knots like a wet rag being wrung dry.
Dreadgod chapter 11
Dross made sure that Lindon interpret his revelation to charity as an absolute breaking of his oath while Lindon had actually found a loophole that would have allowed him to get away with it. Lindon's indulgence with this personality of Dross could have very well killed him if the oath binding him was stronger.

I've got phlegm in my throat that's getting on my vocal chords after 4 weeks of quitting smoking.
Is this normal? Every time it seems to clear up it just comes back, and half the time when I cough I can't get any phlegm up at all. Just feels like it's stuck in my throat.