Hello, I’m a real novice so forgive my naivety, I’m not sure where to start regarding ditching the steroid cream for a skin issue I have.
I’ve been getting an itchy skin rash in my underarm - the doctors aren’t able to identify it and just keep prescribing steroid cream, which clears it up when used but it comes immediately back once I stop.
I’ve tried neem soap, tea tree oil and ACV to no avail and I’m not sure where to go next!
I suspect the cause is my nervous system, I have a young baby who doesn’t sleep etc…

So I recently posted that my Husband was told that he has Parkinson. However, I need to share the story behind that, and would welcome opinions. So about 4-5 years ago he was cleaning up some leaves under a tree in our yard, and large branch broke off and fell on him, he caught it in time with his right hand. Since then he has been having cramp and numbness in his right hand. He never got it checked out. He said last year he started feeling a more pronounced sensation in one finger of the affected hand. As the months progressed he started to feel muscle weakness and spasms in the entire arm. Then in November his speech became slightly slurred and I noticed he had tremors in the right hand. Each week his speech became more slurred and the tremors became much worse. In December I noticed his hand movements were slower, and whenever he is doing any task his bottom lip on the right side protrudes, hangs and quivers. In March his primary doctor referred him to a neurologist, they did a MRI which was okay. The neurologist diagnosed him with essential tremors, and prescribed him Propranolol, which did not help. In April I brought him to the ED, because the symptoms became much worse. His speech is muffled/slurred and oftentimes incomprehensible. He started to walk with a slight shuffle. The bottom lip to right protrudes further and hangs down even more now, whenever he is concentrating on a task e.g driving. He said his right arm feels heavy, and rigid, and the muscles in his right leg feels rigid and weak. His movements are very slow. He told me yesterday his left leg is starting to feel weak as well. So since November of last year he is a totally different person. These symptoms pretty much progressed over a 6 month period. In the ED they worked him up for a stroke, it was negative. The earliest appt I was able to get for him to see a neurologist who specializes in movement disorders is in August. I’m fearing what he will be like at that time. Does Parkinson progress this fast?

Credit to Louella Vaughan on twitter: https://x.com/DrLKVaughan/status/1792439503841583262
So HEE comissioned a national MAP impact assesment study.
https://www.hee.nhs.uk/our-work/medical-associate-professions/impact-case-studies
They claim it's the "first large-scale qualitative study of impact undertaken at a national level." but the jokes frankly write themselves:

• the study uses qualitative data only, taken from interviews with only 36 PAs and their PA leads within trusts (who, naturally, are going to be positive about the project). how is this large scale?!
• admits to to 'potential for bias' since only individuals who already perceive or experience a positive impact of PA and AA in the system volunteered to be part of the study. duh!
• only interested in 'positive impacts' -- why comission an impact assesment if you're only going to cover your ears and close your eyes regarding any bad outcomes?
• discusses barriers to PAs working out of hours -- "lack of supervisory capacity", "insufficient numbers of PAs to enable 7-day working", being "unable to prescribe". Ah, so the F1 working alone on the weekend, they've got plenty of safe supervision?
• admits to PAs not being permitted to request ionising radiation being a limitation, yet describes how PAs are deliberately working around these legal safeguarding limitations
• says PAs working only 9-5 is great because it provides continuity for patients. As if Doctors didn't wish they could provide better continuinity by not having to work weekends ?!
• says PAs are great because can reduce reliance on 'expensive locum doctors' --- so it is explicitly a cost-saving measure -- HEE is now saying the quiet part loud.
• one PA lead quoted as saying PAs are good because "rather than having to train up a new clinician into the role every few months or so you've got somebody that is trained up and you can build on their competencies over time.” -- exactly. doctors do not want to rotate either!! but training is going to the PA regardless.

Using all of these extremely biased interviews, HEE's impact assesment therefore recommends:

• More PAs
• Increased funding for employing PAs in secondary care
• GMC regulation
• Ability to prescribe
• Ability to request ionising radiation
• PAs joining Preceptorship/foundation years on a national scale
• More training in advanced skills for PAs

This should be a national scandal, and it will be. maybe we'll have a big commission and inquiry report in a few decades just like the blood transfusion scandal and lots of politicians and journalists will be asking themselves "how did we let this happen?!"

In 2016, Australia legalised access to medicinal cannabis, allowing patients to access dozens of different cannabis products through prescriptions.
Now the Victorian government wants to take another step in opening the door for medicinal cannabis patients in the state to be able to drive.
In a bill passed last year, the government committed to launch a closed-circuit trial to research the impairment that medicinal cannabis causes on driving.
A push to change driving laws around medicinal cannabis has also been seen in other states such as Western Australia, while in Tasmania it is legal to drive as long as a person is not impaired by the drug.
But how does medical cannabis legislation work, and what are the risks to road safety?

Medical cannabis in Victoria explained

Any Victorian patient, with any medical condition, can be prescribed medicinal cannabis by their doctor if they believe it is clinically appropriate.
There are two groups of medicinal cannabis patients, with different driving rules applying to each of them.
Medicinal cannabis patients using cannabidiol or CBD products have always been allowed to drive in Victoria as long as they are not impaired.
However, some medicinal cannabis products contain a compound known as Delta-9-tetrahydrocannabinol or THC, which is responsible for the "high" feeling associated with cannabis and could impair driving ability.
It is currently an offence in Victoria for a person to drive with any amount of THC in their system, whether the THC comes from medicinal cannabis or not.
Victoria Police currently conducts random roadside drug testing throughout Victoria, with saliva tests that are positive for THC resulting in a drug-driving charge.
Drivers with THC in their system faced mandatory licence suspensions and fines if caught.
The new trial by the government will seek to test just how impaired people with medicinal cannabis in their system are whilst driving.

How will the trial work?

Drivers who use medicinal cannabis will be taken around driving courses with an instructor at special closed road facilities such as METEC in Bayswater North and AARC in Wensleydale.
Minister for Roads and Road Safety Melissa Horne said the trial, conducted in partnership with Swinburne University, would be a world-first.
"There is nowhere in the world that actually has got that standard way of measuring impairment through medicinal cannabis," Ms Horne said.
"It is a basic human right — we've got a legally prescribed drug, let us be able to measure what that looks like in a road safety environment."
About 70 participants will take place in the trial, due to begin in September this year.
When first announced last year, the trial was praised by legal groups such as the Australian Lawyers Alliance, who have dubbed driving laws penalising medicinal cannabis users as "outdated and unfair".
"Cases are coming before the courts every week where people are losing their licence and their livelihood because they are taking prescribed medicinal cannabis and driving," Australian Lawyers Alliance spokesperson Greg Barns said.
"Drivers who take opioids or other prescription medication do not find themselves in court or risk losing their license, and neither should drivers who have taken a prescribed and legal dose of cannabis."
Ms Horne would not however say when any potential law changes would be passed if the trial is found to be successful, with results due in 2026.

Is it dangerous to drive with THC in your system?

According to the VicRoads website, THC is a psychoactive substance that has been shown to impair cognitive and motor function, increasing your risk of being involved in a motor vehicle crash.
A meta-analysis of studies conducted in 2021 found cannabis increased the risk of crashes somewhere between 11 and 42 per cent.
Researchers found the added crash risk from cannabis similar to that of the legal blood alcohol content (BAC) limit for driving, with the high end of estimates similar to that of prescription drugs like antidepressants.
Internationally, there is a lack of research on the effects of cannabis on driving impairment.
In the United States, where recreational cannabis is legal in some states, the drug is the second most frequently found substance in the bodies of drivers involved in fatal motor vehicle accidents after alcohol.
A study of emergency department presentations in Canada, which legalised cannabis in 2018, showed no evidence of significant changes in traffic-injury emergency departments.
Driving while drug-impaired remains illegal in both countries, but the measurement of what constitutes impairment differs across state and country lines.
In Canada, any reading above 2 nanograms (ng) of THC per millilitre of blood while driving is considered an offence, while in the US state of Colorado that figure is 5ng or above.
Meanwhile, in states like New York and California, penalties are based on whether law enforcement can prove a driver has been impaired by a drug.
For now, the Victorian government has not made clear what any introduced driving laws may look like, should the trial be successful.

How have medicinal cannabis advocates reacted?

Legalise Cannabis MPs have criticised the government for moving too slowly on the issue, saying millions of dollars are being spent to conduct research that has "already been done".
"In 2023, Dan Andrews promised an answer 'in coming months' followed by a guarantee to have it fixed by 2024. Now, with a new premier, it's mid-2026 at best. She's in the slow lane," MP Rachel Payne said.
“Given the 10-year time blowout, I am calling on the premier to follow Tasmania’s lead and allow Victorians, unimpaired and prescribed medical cannabis, to drive without fear of recrimination."
Ms Payne noted a similar study that had already been conducted by Swinburne University, where 40 people were tested on a virtual driving simulator after consuming medical cannabis, as opposed to a real vehicle and road as planned in the new trial.
The Australian Legal Alliance (ALA) has also called for the prosecution of medicinal cannabis patients who are driving while unimpaired to be paused while the trial is undertaken.
ALA national president Shaun Marcus said drivers were being prosecuted merely for having a substance in their body rather than potentially dangerous impaired driving.
"That is not what road safety legislation was designed to protect," Mr Marcus said.
"The ALA is calling upon the government to not prosecute those persons currently before the courts between now and the end of the trial.
"We see the detrimental effects and over-representation of certain communities before the courts, and we say it really should change quicker."
https://www.abc.net.au/news/2024-05-21/victoria-medicinal-cannabis-driving-cbd-thc-explaine103872650

Even before Indiana abortion restrictions took effect last year, Indiana in 2022 had a lower ratio (9.86) of nurses to 1,000 population than neighboring states of Kentucky ( 9.97), Michigan (10.11), and Ohio (11.09). Indiana's new abortion restrictions may result in existing and prospective nurses choosing other careers, leaving Indiana, or becoming traveling nurses. Young women especially are conscious how abortion restrictions may impact their health needs personally, let alone professionally as nurses.
https://nursejournal.org/articles/the-us-nursing-shortage-state-by-state-breakdown/
As noted in the above article, nursing shortages are a national problem to be aggravated by an expected increase in retirees as well as increased demand as Baby Boomers age and require more medical services.
<< A lack of nurse educators keeps nursing schools from being able to admit enough students to address the shortfall. A shortage of nurses means more burnout and more nurses choosing to leave the profession, contributing to the shortage.
In addition, the aging of Baby Boomers means that more nurses are retiring at a time when an aging population has a greater need for healthcare providers. The COVID-19 pandemic exacerbated the nursing shortage.>>
Many Indiana women rely on medication abortions aided by doctors practicing remotely in other states, who often rely on "shield laws" in those states to protect them from prosecution in states with abortion restrictions. If anti-abortion states are successful in blocking these shield laws and restricting telemedicine abortions, Indiana may become even less attractive to young women concerned with their own reproductive rights.
<< A clash is looming between anti-abortion red states and the blue state telemedicine shield laws trying to preserve abortion access.
More than a dozen states have laws shielding medical providers and others from out-of-state investigations and prosecutions regarding abortions and gender affirming care. But six states — Colorado, Massachusetts, New York, California, Vermont and Washington — have gone even further.
Those shield laws offer protection for doctors, nurses and other practitioners who prescribe and send abortion pills to people living in states that ban or severely restrict abortion.>>
https://thehill.com/policy/healthcare/4671299-abortion-bans-clash-shield-laws/
<< According to a new report from the abortion-rights research group Society of Family Planning, nearly 8,000 people per month in states with bans or severe restrictions were getting medication abortion from clinicians operating under shield law protections from October through December 2023. >>
The personal turmoil of nursing in states with abortion bans and restrictions also lessens the desirability of those states not only for nursing recruits, but also existing nurses.
<< National articles provide a look at how some nurses and physicians are quitting or moving because they cannot handle the trauma they see when women are denied health- and life-saving abortion care during a pregnancy crisis. For instance, Leah Wilson, a Texas nurse, had to watch her pregnant patient for days as the woman’s infection worsened and drew closer to sepsis because the fetus still registered a heartbeat when the woman’s water broke at 19 weeks of pregnancy. The nurse said, “You know what? I’m not doing this anymore,” and she left her job. Wilson had worked with high-risk pregnancy patients before and provided them with support for fetal loss, but she had never seen patients denied standard medical care until after Roe v. Wade was overturned.>>
https://www.reliasmedia.com/articles/abortion-bans-lead-physicians-nurses-to-avoid-certain-states
https://www.nursingworld.org/practice-policy/work-environment/health-safety/srh-advocacy/
Shortages of nurses increase the workplace burdens and stress for remaining nurses. This can compromise the quality of healthcare for patients, as does Indiana laws providing for lax continuing education requirements and lowered training supervision quality for student nurses.
Unlike neighboring states, Indiana has no continuing education requirements for RNs or LPNs.
https://www.nursingce.com/ceu-requirements/indiana
https://www.nursingcenter.com/continuing-education/ce-state-requirements
<< Estimates predict that Indiana would need an additional 5,000 nurses by 2031, equal to graduating an additional 1,300 nurses each year until that time, according to the Indiana Hospital Association. >>
https://indianacapitalchronicle.com/2024/02/12/indiana-has-a-problem-a-lack-of-nurses-and-lawmakers-are-trying-to-help/
To increase the supply of nurses, a new bill would ease the requirements for nurses supervising student nurses.
<< While most of the bill received glowing support in testimony, one issue was a bit of a sticking point for nurses working in clinical settings: language striking minimums for preceptors, or licensed nurses supervising students during rotation. Previously, preceptors needed 18 months of experience before they could be drafted to teach and mentor the next generation.
The new law has no minimum requirement.
Rep. Cindy Ledbetter, a nurse practitioner with a doctorate, cautioned against the move, saying unprepared nurses would be given to students to address a shortage.
“My concern is you have a brand new nurse and the hospital requires them to precept and they’re not ready to translate what they’ve learned in the classroom themselves into a real-world scenario,” said Ledbetter, R-Newburgh. “(I’m concerned) that we’re going to … lose more nurses on the other end.”>>

Throwaway to maintain privacy.
I'm a parent of a teen who saw an NP via telehealth. I can't even bring myself to talk about the experience. Teen was misdiagnosed by NP with depression and prescribed fluoxetine. Was on it for 6 months, completely stopped growing. My discomfort with the NPs quickness to diagnose after 10 minutes of chatting (and ignoring my observations as a parent) grew and I ended up learning a lot about NPs. I did not know at the time that they have limited training. This particular one went to a well-known diploma mill school. I feel a TON of guilt for how this went and should have had the teen see a doctor. I didn't know. I know now.
The issue now is that I suspect this NP is practicing solo. They have a website. They are the only staff member on the website. There is no mention of a supervising MD. None at all. The office manager using the same email as the NP. Office manager says there is no office so they don't have in person appointments. NPs website gives an address.
The NP does not offer in person appointments at all. They are all online. The photograph of the NP does not look like the person we had an appointment with. There are other dubious elements of this story, but they might be too specific for me to mention here while trying to maintain privacy.
A lot of this practitioner's early reviews are from people on a different continent.
I don't know what, if anything, I should do about this. We are no longer seeing this NP. Am I being overly paranoid? Something feels really off about this, and many reviews call this NP a "wonderful doctor." NP responds to reviews but never correccts the ones that call them "Dr."

Ok soo.. this has been such a shit show trying to be taken seriously about my symptoms. No I didn’t have a bullseye rash but I had all the symptoms for a few days and still some fatigue. I went to my doctor who only tested me for 2 types of Lyme variants … since I know nothing about Lyme testing I thought this was normal… they came back negative which means nothing as most of you know since testing early on for Lyme is unreliable. I insisted I wanted doxy just to be safe and he refused to prescribe it to me. He instead did another physical exam on me and referred me back to Labcorp to get more testing done for Lyme. I was surprised because I thought he tested me for all Lyme variants already? Nope. On my way to get tested I noticed on the lists of tests he sent out , one was for HIV. I was shocked because we NEVER had any conversation about this ?! Like this never came up. He’s been super dismissive and condescending. I’m on Medicaid so my options are limited when it comes to finding a primary care doctor in my area. They had to draw 6 huge vials of blood this time and I’m assuming a lot of that was for the HIV test. Is this ethical ?? That he added that test without telling me or having a conversation about it ?? Now I’m all paranoid and anxious waiting for my test results , it’s been days and I still haven’t heard anything. Wtf. Im really upset about this situation and being treated like this. After my last visit with him before I got my recent blood tests done , I went straight to urgent care determined to get doxycycline since my doctor still refused to give it to me. They gave it to me but only for 10 days. The first day I threw it up cuz I stupidly didn’t eat before taking it. So now I only have 9 days worth which just seems so pointless. I asked my friend who lives in Mexico to send me some but they didn’t end up sending it …. lots of people on here have sent me links of where to get it online. I’m going to check that out next I guess. I just feel like giving up though. Meh.

I have been posting/commenting on here for a while now. I started my Cushings journey in September of last year and I feel incredibly lucky to have found this subreddit because it helped me so much. Being able to read and speak to those who are going through/have gone through similar things has been so helpful. I know that I wouldn’t have had nearly as much courage to advocate for myself because I wouldn’t have the knowledge and warnings from this subreddit.
I apologize now for any spelling mistakes. To be honest it’s 1:34AM on a Tuesday morning. I am so tired but I can’t sleep. I am a ball of anxiety at this point due to my upcoming MRI and I cannot think about anything else. I’m writing this in part just to get my anxiety out.
To make a long story short, I discovered I had high cortisol last year in September. I decided to finally go to my primary care doctor and talk to her about my difficulties losing weight. My family has a history of thyroid issues so she tested that along with many other things. She just happened to think to test my cortisol and when it was very high, she expressed concern that it could be cushings (due to the many symptoms I’d shared with her that could be cushings) and she referred me to an endo.
I started seeing the endo and my blood cortisol has been tested many times and it’s high every time. However, my urine was normal, my midnight saliva was normal and I suppressed on dexamethasone. But still every time she orders me a cortisol blood test, it’s high. My acth is also either normal or on the verge of high.
She expressed concern that I had so many normal tests. Due to this subreddit, I asked if it could be cyclical cushings. She agreed it could be and that I do have many of the symptoms. She also couldn’t come up with another reason why my cortisol would be so high. We agreed that we didn’t want to treat the symptom but rather find the cause. So she finally agreed to order me an MRI of my abdomen. She decided that if anything, it’s more likely to be adrenal, but then my MRI was unremarkable.
I saw her again after my abdomen MRI results and we agreed we are at an impasse. I shared with her that I still think it could be cushings, because I have read many stories similar to mine where people still had it (mostly pituitary source). I also expressed that I didn’t want to take the chance of this being the case, but missing it and then just not knowing.
She agreed again with me that it was possible and at this point she didn’t have any other ideas. She also agreed that it’s better to know. She agreed to order me a brain MRI, with and without contrast, focused on the pituitary. She did tell me she was worried my insurance would not cover it due to my normal results even though I have many high blood cortisols. However, the MRI was approved by my insurance (I do think she had to do a bit of convincing). She also told me that it could always be endoscopic cushings which she isn’t sure how to go about finding/diagnosing. She mentioned to me that if nothing is found on my brain MRI, that she would suggest I get a second opinion from somewhere like UPENN since they have a whole cushings team. Of course, you first meet with their endo and then they decide if there is cause for you to see the cushings team. She was able to admit to me that if there is nothing on my brain MRI she just isn’t sure what else to do for me. She said she would of course consult her colleagues to see if they have any ideas, but if not she doesn’t have any ideas or answers for me as to why my cortisol is high. Like she said, it could very well still be cushings, just endoscopic, but she just isn’t sure how to go about even looking into that.
Honestly, I really appreciate her honesty and bluntness. She has been very caring and understanding throughout this process and I feel like she really listens to me. I also appreciate that she will admit her lack of knowledge in this area and refer me elsewhere. I had already been looking into UPENN anyway just in case since it’s never a bad idea for a second opinion and since they’re so close it makes sense. At lease since they have cushings specialists, if I go there and they tell me there is no reason to think it’s cushings-I trust that.
But for now, my brain/pituitary MRI is scheduled for tomorrow (Wednesday 5/22). I am scared they are going to find a pituitary tumor, but in many ways I’m more scared that they won’t. No one in my life understands me when I say that, and I know that I have been a lot luckier than some in my journey. But to be honest these last few years have been the toughest/worst of my entire life for so many reasons. I am so beaten down emotionally and mentally. I have just known something was wrong but I couldn’t explain it and I couldn’t prove it, but now there’s at least proof that something is going on-even if we don’t know what. I am just so sick of all the test and doctors. I am sick of feeling awful. Part of me just wants it to be over. Wants them to find something because then at least it’s confirmed-I was right. And then if I know what it is-I know what to do about it and there is a light at the end of the tunnel. The worst part is having to explain to a doctor that you know something is wrong and explain how. Having to explain all these symptoms that seem random but might not be. Having to wonder if I will ever find out what is wrong and feel better, questioning my sanity. At least if they find something-that means it’s real and not just in my head. It means we can make a plan and I can work towards getting better.
I don’t know what I want more-not to have a tumor or to have a tumor. It feels wrong to hope for a tumor-to hope I can be officially confirmed and diagnosed as sick. But I am sick of my family and friends telling me that I’m worried for nothing. The last thing I want to do is have to start all over with new doctors, explain the same stuff and do all the same tests again. I cannot get multiple blood tests every week forever. I will go crazy-crazIER.
Not to mention that I’m extremely claustrophobic and MRIs are hell. I have to get my primary care doctor to prescribe me a very strong anti-anxiety pill to take beforehand so that I don’t have a panic attack. This journey has been tiring every step of the way. I don’t want to put myself through this but I will just to know what’s wrong.
TLDR MRI of abdomen was unremarkable, brain MRI is this Wednesday (tomorrow) and I am terrified because I’m claustrophobic but also that they won’t find anything and then I’ll have to start this whole process over when I go to UPENN for a second opinion.
Thanks if you read this. I am always sending the best vibes for all of you, please send some good vibes my ways. I hope I find out I am right on Wednesday so I can finally, officially, begin planning my treatment/recovery.

I sent my non restricted-PAL through the online services, and was notified it was officially sent off May 20th, 2024.
I'm worried I'll be rejected because I did check off one of the boxes, which was that I tried committing suicide 4+ years ago and was court ordered and escorted by police to a mental health center.
I explained in the box that I've attended counseling, properly diagnosed by a psychiatrist and my doctor has prescribed the right medication for me and I'm continuing to live my best life.
Do they automatically reject people who have attempted such things or do I still have a chance?

Situation 1: Michelle, an international student, will be studying in Hualien County to obtain her degree and hopes to gain a better understanding of the National Health Insurance.
Q1: How and when can I obtain the NHI (National Health Insurance) card? A1: NHI stands for National Health Insurance, which is necessary for all individuals living in Taiwan. Of course, the process of obtaining NHI depends on your residency status as a foreigner living in Taiwan. Let's break down how and when you can get NHI!
Foreign Students If you've come to Taiwan to study at a university, getting NHI is quite straightforward. It's important to remember that foreigners can obtain NHI only after living continuously in Taiwan for six months on an ARC (Alien Resident Certificate), but you are allowed to leave the country once for up to 30 days during this 6-month period. After these six months, your university will collect insurance fees for each semester upon registration. As a student, you'll only need to pay the insurance fee, which is 826 NTD as of 2024, and then wait for notification from the university that your card is ready for collection. Insurance fees are collected from September to February in the first semester and from March to August in the second semester.
International students can be employed part-time in Taiwan. In this case, students with a steady part-time job should be registered in the program as employees through their employers. Don't forget to inform your university about this. The university will reimburse you a portion of the insurance fee you've already paid.
If you are seasonally employed, meaning you are a full-time student who only works during summer and winter vacations for fewer than 3 months and returns to school when classes resume, you do not need to change your enrollment status during the period of employment.
Foreign Workers A foreign worker must be registered in the National Health Insurance Program from the first day of employment. Therefore, those working in Taiwan are not subject to the six-month waiting period. Your employer should register you and be responsible for paying your insurance (formerly known as the "insurance registration organization").
If you're a company chairperson or owner, you need to set up your own insurance registration unit. If you have another primary job, you can be insured through that company or agency without enrolling as a responsible person.
If you're employed but don't have a fixed employer, like being a member of an occupational union, a farmers' or fishermen's association, or are actively involved in farming or fishing, you should enroll in the National Health Insurance through your respective union or association.
If you are working two jobs at the same time, then you should be registered in the NHI program through your main employer. Your main employer is the one where you work more hours; if the hours are similar, then income can be the deciding factor.
Unemployed foreigners If you are unemployed and qualify as a dependent, you should be registered in the NHI program through your employed spouse or direct blood relatives.
If you cannot be enrolled through your spouse or direct blood relatives, you are required to enroll in the program at the local administrative office where your household is registered, under the identity of a "regional citizen."
If you are an unemployed veteran or a dependent of a deceased veteran, then you can enroll in the program through the administrative office where your household is registered under the identity of "veteran."
For more information, please feel free to ask or refer to the NHI handbook (click the specific link below).
Q2: What medical services are covered by the NHI? A2: The National Health Insurance (NHI) in Taiwan covers a wide range of medical services, such as: Outpatient services Inpatient services Emergency care Surgery Laboratory tests Prescription drugs Dental care Mental health services Traditional Chinese Medicine Rehabilitation services The medical payments include diagnosis, assessment, laboratory tests, consultations, surgical procedures, anesthesia, prescriptions, supplies, therapies, nursing care, and covered hospital accommodations. Essentially, all essential healthcare services are included in the system.
Q3: How can I understand the cost of services under NHI in advance? A3: Under Taiwan's National Health Insurance (NHI), patients are required to make co-payments for medical services, including hospital visits, outpatient care, prescription drugs, and various medical procedures.
Let's see a breakdown of typical co-payments for various medical services under NHI! Visiting a hospital or clinic with a referral: Co-payment for Medical Center with referral is fixed at 170 NTD. For Regional Hospital it is 100 NTD. For District Hospital it is 50 NTD. And for Clinic it is 50 NTD. Visiting a hospital directly without a referral costs more: Co-payment for Medical Center without referral is fixed at 420 NTD. For Regional Hospital it is 240 NTD. For District Hospital it is 80 NTD. And for Clinic co-payment remains fixed at 50 NTD. For visiting dentist and traditional Chinese clinics, the co-payment is fixed at 50 NTD regardless of the level of medical institution.
Important to know For patients with a disability identification, the basic co-payment is charged at the Clinic rate (NT$50) regardless of the level of medical institution visited by the patient.
The following situations are regarded as visits with referral: Follow-up visits within one month of a medical visit with a referral sheet, limited to a maximum of four times. The first follow-up visit after outpatient surgery, emergency surgery, or discharge from the hospital. The first follow-up visit within six weeks after childbirth. Therefore, the co-payment for such visits is charged according to the standards of medical visits with referral, and hospitals may issue relevant certificates for patients. During a course of treatment, patients only need to pay the co-payment for their initial visit (excluding rehabilitative physical therapy and Traditional Chinese Medicine traumatology).
Emergency Care Co-payment Standard: Medical Center: 740 NTD Regional Hospital: 400 NTD District Hospital: 150 NTD Clinic: 150 NTD Near-poor Households/Individuals with Disabilities: Medical Center: 550 NTD Regional Hospital: 300 NTD District Hospital: 150 NTD Clinic: 150 NTD
Co-payment cost for outpatient prescribed drugs
Regular prescriptions: If the cost of the medication is equal to or less than 100 NTD: In Clinics and District Hospitals: Patients are exempt from co-payment (no co-payment). In Regional Hospitals and Medical Centers: The co-payment is 10 NTD. If the cost of the medication is equal to or greater than 101 NTD:
In all levels of medical institutions, an additional 20% will be charged for every 100 NTD. For example, if the price of medication is in the 101-200 NTD range, then the co-payment is 20 NTD; if in the 201-300 NTD range, then the co-payment is 40 NTD. In Clinics and District Hospitals: If the medication cost starts from 1001 NTD, the upper limit for co-payment is reached, and the co-payment is fixed at 200 NTD. In Regional Hospitals and Medical Centers: If the medication cost is in the range from 1001-1500 NTD, the co-payment is fixed at 200 NTD.If the medication cost starts from 1501 NTD, the upper limit of co-payment is reached at 300 NTD.
Refillable prescriptions: In Clinics: Patients are exempted from the co-payment. In District Hospitals, Regional Hospitals, and Medical Centers: The first time filling a refillable prescription follows the same rules as outlined above for regular prescriptions. From the second refill onwards, patients are exempted from the co-payment.
Important to know For Traditional Chinese medication co-payment, the same system as that of Clinics is used. Costs under 100 NTD are exempt; for costs equal to or greater than 101 NTD, an additional 20% will be charged for every 100 NTD. At Dental Clinics, outpatient prescription drug expenses are exempted from co-payment. Emergency Care Prescription: For Clinics and District Hospitals: 150 NTD For Regional Hospitals: 400 NTD. For Medical Centers: 750 NTD. I hope now you have a better understanding of how to calculate the cost of medical services under NHI. Feel free to ask more questions or refer to this webpage (click the specific link below).
Q4: What services are completely free under NHI? A4: With NHI, you can access a wide range of medical services at very affordable prices, and some services are fully covered! However, it's always a good idea to ask your doctor or a consultant at the hospital/clinic about which services will be covered.
Let's break down what kind of services can be fully covered under NHI: Basic Medical Examinations: These are routine tests to check your health, like measuring blood pressure, checking cholesterol levels, and assessing kidney function through urine tests. Preventive Services like Vaccinations and Screenings: This includes vaccines to protect against diseases like measles, mumps, and rubella, as well as screenings for diseases like cancer or diabetes. These screenings aim to catch health problems early for easier treatment. Essential Surgeries: These surgeries are necessary to treat a medical condition and improve health or save lives. For example, removing an appendix, fixing a broken bone, or treating a serious infection. Hospital Stays in General Rooms: This means staying in a hospital room shared with other patients (one room with 3 beds or more) and having basic facilities. General rooms provide standard care for conditions that don't require intensive monitoring or specialized equipment. Some Prescription Medications: Certain medicines prescribed by doctors are fully covered by NHI, so patients can get them from the pharmacy without paying anything. These often include essential medications for common conditions like high blood pressure, diabetes, and infections. Medications with a cost below 100 NTD will be fully covered or will require a 10 NTD co-payment. Dental care: Most medications prescribed by dentists are fully covered by the National Health Insurance (NHI). However, it's important to note that full-mouth anesthesia is not covered. Also, you have the right to receive two dental cleanings per year fully covered, allowing the general public to get dental calculus removal. People with tooth decay may be eligible, depending on a dentist's evaluation, for fluoride varnish treatment. As long as the cavity does not reach the pulp (where the tooth's nerves and blood vessels are located), it can be fully covered by the National Health Insurance (NHI). Generally, the National Health Insurance (NHI) will cover the extraction of wisdom teeth, supernumerary teeth, and impacted teeth. However, extractions for corrective purposes (teeth that are intact and without decay problems) will not be covered by NHI.
Medical expenses in Taiwan are relatively inexpensive, so don't worry about spending a lot of money when seeing a doctor. Therefore, don't be afraid to go to the hospital.
Q5: In which hospitals can I utilize NHI services, specifically at Hualien hospitals? A5: Here is the list of hospitals in Hualien in Chinese (the English version will be posted and updated later). But if we talk about the most popular hospitals in Hualien where you can definitely get assistance in English, then we can list these hospitals: Mennonite Christian Hospital Hualien Tzu Chi Hospital Hualien Hospital Smiles-Dental
Q6: Is it possible to receive NHI consultation in English? A6: Yes! It is possible to receive NHI consultation in English! The back of the NHI card has a hotline number for inquiries: 0800-030-598, or by mobile phone call 02-412-8678. Calling the number is free of charge.

I bought my first home. The day I moved in, I heard the most aggressive screaming I've ever heard in my life. I thought maybe the neighbour was going to kill someone. It was that intense. I called the police who said they'd conduct a welfare check. When they turned up I heard the neighbour scream "I'm going to fucking eat you!!!!" The police left and never got back to me. After the rest of the day full of screaming, I called again and requested to be notified with the outcome. Another welfare check, no call. I called the station and was told that if I wasn't called back in 15 minutes to call again. I did. Nothing. After more back and forth I finally got an answer the next day: The neighbour is schizophrenic and is medicated. There is nothing more that can be done.
The screaming continued all day and all night. This is no exaggeration. Literally all through the day and all through the night. For hours and hours at a time. He would stand in the courtyard right next to my house and scream until he was purple in the face. He would pace back and forth screaming at the voices in his head. I called Barwon Triage. They couldn't help. I called Barwon Health but was told that without a name there is no way for them to look up the individual. They told me to keep annoying the police. The more I called the police, the more they would be forced to do something about it, apparently. So I did. The same thing would happen: they'd ask him to keep the noise down but once they left he'd start screaming at full volume again.
One day, after a month of living there, I got a knock on the door. A lady said "hi, I live next door and I want to apologise for my grandson. He's the one doing all the screaming. I own the house and he lives in the garage out the back. I've been trying to catch you but you're always at work" (I was home every night from 6pm...). I asked her if he was medicated. She replied "he was seeing a group in Corio Village but I'm not sure if he still does. I'm pretty sure he's self medicating as he smokes all day in there. I'm really worried the early learning centre across the road will be able to hear the profanities he yells". I asked if she would be able to find out which group he was seeing so I could call them and see what was going on. She said she would. Weeks passed and I heard nothing. The screaming seemed to get worse. I went into the police department and explained my situation. They said there is nothing they could do and that my only option was to get an intervention order. So I went to the magistrate's court with my application. I was told that there was no point getting an intervention order as the neighbour has a mental illness. They also said that the police send people to get intervention orders when they don't know what to do or don't want to follow something up. "The police absolutely have the power to take an individual in to get assessed but that would involve being responsible for them for the duration of the process, and involves paperwork, both of which they don't want to do". Again I was told to keep annoying the police as they would soon get tired of the welfare check calls and do something about it.
The constant aggressive screaming was really starting to affect my mental and physical health. It didn't matter where I was in the house, it was so loud that I couldn't concentrate. I was constantly stressed. And all of my spare time was spent trying to fix this situation.
I called the police again during another screaming session. I said that something more than a welfare check needed to be done as nothing was changing. They did another welfare check. The officer called me back and said "I've had a word with him and told him to keep it down". I explained that this approach has no effect because he suffers from schizophrenia and as soon as the police leave he starts screaming again. He kept screaming so I called the police again. that's what I was advised to do and I didn't know what else could be done. They didn't care. They didn't do a thing this time.
I contacted the Geelong council and was told there is nothing they can do about it. I contacted the ombudsman, they couldn't do anything about it. I contacted NDIS, they also could do nothing.
I contacted the Corio Police Department again and told them of my situation, how they had wrongly sent me to get an intervention order, and that both Barwon Health and the Magistrate's Court had informed me that the police could definitely do something about this situation. "They're full of it" is the response I got. That's actually what I was told.
I finally saw the lady from next door again as she was getting out of her car. I hadn't wanted to knock on her door as I didn't know how her grandson would act if he answered. I asked her if she'd gotten the information I'd asked for and she shook her head as I noticed her grandson also getting out of the car. I introduced myself. he seemed nice enough but vacant. The grandma said she'd come over in half an hour to give me some jam but it was just an excuse to talk. She came over and asked why I'd called the police. "I asked you to help me get the name of the group that cared for him a month ago". She looked sheepish. "I'm not getting any sleep as he screams all night and it's started to affect my work and health" I said. She said she was so sorry that her grandson was doing this. I said "It's not his fault though, he can't help it", and she said "well, that's not true, he can be very polite and reserved when the police come in". We both agreed that he wasn't getting the help he needs as he was constantly in anguish. I asked for his name and her permission to call Barwon health on her behalf. She was happy to oblige.
I called Barwon Health and gave them his name. They told me that he was getting care at the Corio Community Health Centre and they put me through to them. I told my story to one of the staff there and she said she'd bring it up at the next morning's meeting and to keep calling. She said that the more I called, the more it would be pushed to be actioned.
The second time I called I spoke to his case worker. She was new to this case. They had no idea he was screaming every day. I told her that he might be self medicating. "With THC" she replied. "Oh, so you know he smokes weed?". "We can't officially state that we do or don't". We give him an injection every fortnight". "Well it's not working, or the weed is cancelling it out because he never lets up", I said. "Thanks for letting us know..."
The conversation didn't go anywhere. It was so disheartening.
I just want to say something about my health at this point.
Being subjected to, and anticipating the constant screaming was seriously affecting my well being. He was waking me up at 2, 3, 4, 5 in the morning. My cortisol would spike and I would be on edge for the rest of the day. I wasn't getting more than an hour of sleep a night and was constantly very, very anxious. I was constantly in fight or flight. My heart rate would beat dangerously fast and wouldn't come down for hours, no matter what I did to relax myself. If I tried to nap after a long shift, he would wake me up almost immediately. I practiced the breathing exercises my therapist gave me but my anxiety would override them. Even if I left the house for hours. My chest started hurting at times. I couldn't enjoy anything in the space of my own home. Playing instruments, reading, watching films, playing with my dogs etc. were all ruined by getting drowned out by a screaming schizophrenic. I began forgetting where I was, which my doctor told me was disassociation. She put me on blood pressure medication and prescribed me beta blockers because my blood pressure was so high. I've never had a problem with that before in my life. I really believe my body has been damaged by this.
I kept asking for help and tried to do everything right but although some of the authorities and mental health services were sympathetic, most were dismissive and rude. Being helpless made me pissed off but because I couldn't get out of that situation it just turned into more and more anxiety.
I kept having to call Barwon Health to be put through to the Corio Community Health Centre because at the time they wouldn't give me the name of the centre so I could call myself. One of the Barwon Health staff got angry at me, even though Corio Community Health had told me to keep calling. "Maybe YOU should see YOUR doctor and get a mental health care plan" she said. "I do see a therapist and I had to get medication for the stress this has put me under but I don't see why this is relevant. Why are you being like this?"
The Corio Community Health Centre didn't care. I would call exasperated because I was really not doing well, and their response sounded like they were reading off a sheet. No emotion. I told them I saw them arrive next door to administer the injection and that he screamed immediately after and for the rest of the day. They couldn't have cared less. I asked if I could play a recording to demonstrate what this guy was doing all day. "I mean, if it helps you" was the response.
I contacted two members of parliament and they advised me to contact Legal Aid, and Barwon Legal. Legal Aid couldn't do anything about it, and Barwon Legal seemed pissed off. "What do you want us to do about it?" she snapped. "I was advised to call here from a member of parliament", I answered. "Why don't you get an intervention order?"...
So now I have to sell my house after 6 months. Because it is my first house I will have to pay back the stamp duty and after the sale I'll be lucky to break even. I'm painting my house to put on the market and he screams the whole time. I feel spiteful. I'm losing my house, money, my mental and physical health, and all of my time. I feel I should be compensated, but from who?
Any thoughts or ideas are welcome.
Thanks for listening.

TL;DR - after several years of bad sleep, I exhausted every other treatment and am now in CBTI. But CBTI feels like they're treating a different person with different sleep issues. Does it actually work? (I know there are papers claiming that it works, but the execution seems so terrible, I don't see how it could work.)
M47. Around 3.5-4 years ago, my sleep started to degrade and I began to have memory issues. I've jumped through a lot of hoops since then - three sleep studies, 10 months of CPAP (only for the lab sleep study to show inconsequential sleep apnea), urologist/ultrasound showing no issues, etc. I'm now doing CBTI (with my second provider, the first was useless.) That last sleep study showed that my sleep goes through all of the normal steps, and I'm not being woken up by a need to urinate or leg movement or any other potential issue.
My basic sleep pattern is:

1. Take THC edibles (20 mg is best) prior to bedtime
2. Lay down, turn off lights, fall asleep within 5 minutes (never had an issue with sleep latency)
3. Wake up after ~90 minutes
4. Lie there for a couple of minutes, get up and go to the bathroom, come back, fall asleep in a few minutes
5. Repeat steps 3-4, but at some point, I can't fall asleep again
6. If it's 3:30 or earlier, take more edibles (5-10 mg)

The CBTI provider is very focused on, as a first step, getting me to stop taking the additional dose in the middle of the night. He now wants me to take sleeping pills to get me to sleep all night with just the nighttime dose. He suggested Dayvigo, but my PCP said she wouldn't prescribe it; she said if I wanted sleeping pills, I should start with Trazodone, and only if that didn't work, should I move on to something else.
I really don't have much faith in CBTI at this point. Though my new provider is better, it always feels like they're trying to force-fit me into somebody else's symptoms. I tried to cut my THC use at the provider's request, but I end up having a terrible night's sleep after 5 or 6 nights, and it seems like CBTI says I need to just suck it up and somehow make it through the day.
I told the CBTI guy that the day after a poor sleep (say 4 hours) are very difficult. My cognitive capabilities are extremely degraded - I have more memory trouble than usual, and I will often just trail off in the middle of a sentence or lose track of what I was doing. I also feel like I'm a danger driving home from work. I have a 50-mile drive and at the 30-35 mile mark, I have to talk to someone on the phone and pull on my hair or dig into my scalp to stay awake. Thankfully I'm only going in two days/week.
CBTI guy seemed to dispute my reality. Something about how one bad sleep shouldn't do this to me, and that people find out that they don't quite perceive the impact of their sleep issues correctly. Say what you want, but I think I'm a pretty good judge of when I feel like I'm going to crash into the divider on the highway.
It all feels very adversarial. The first provider I had was atrocious. She would get mad at me for using the term "sleep cycles", she told me that my radar sleep sensor doesn't work even though she didn't know what it was (and I tried to explain that I merely use it to keep track of how many times I got out of bed during the night, which it's really good at, but she wouldn't listen), and even got annoyed at me for saying I wake up 4-5 times/night because in reality I have additional imperceptible wakes (the sleep study showed 14 total) but it should be obvious that I'm only talking about the ones I notice!
In my most recent appointment with the new guy, I told him that I tried taking THC only at bedtime as we discussed, but eventually I ended up getting a really bad sleep, and all I can think about the next day is how I'm going to go to bed early and get more sleep to make up for the previous night. He threw out the whole "paradoxically, that doesn't work to go to bed earlier, you need to maintain the same bedtime and wake time." This feels like he's just grafting CBTI dogma onto me. Yes, many people who have insomnia do not get more sleep if they go to bed earlier. But I do! And if we have no plan and we're messing with my THC dosage, I'd much rather recover from a bad night's sleep than do some sleep hygiene b.s. that has not been shown to improve your sleep.
I asked how many weeks the treatment would take if we went down the sleeping pills path and it took forever to pin him down at 8 weeks. I said it would be good to give me a doctor's note so that I don't need to drive into the office. He thought this was very weird (it was actually suggested to me by the previous provider) and unnecessary. But if we're going to restrict my sleep and make me exhausted, why would you want me to do something that's dangerous to myself and others?
I could go on. It feels like the goal is to find fault with what I say and do, but without offering me any details into what the plan is. I told him today that I needed a schedule with stages and I couldn't deal with these ad hoc modifications to my sleep. He agreed but said it would take him time to do it - am I the first person who ever asked for this?
Does this sound like typical CBTI?

Promising Pathway Act 2.0
This bill is going to be introduced in Congress on this Thursday (hopefully). I need everyone’s help in getting it passed. I made a quick and easy way to send letters to your congress people. Just go to https://virtualtrials.org/activism and fill out the form. You can edit the sample letter – explain your connection to brain tumors, or just send it as is.
The bill creates a new pathway to fda approval called conditional approval and a learning system so we can figure out the best way to use these drugs alone and in combinations.
Conditional approval means that once a drug is shown to be relatively safe and early indications that it helps, it gets approved. The bar is basically after a phase 2 trial where there is enough evidence to allow it to move forward into a phase 3 trial. Once it gets conditional approval, your doctor can prescribe it and insurance should pay for it. Then everyone who uses a treatment approved under this pathway has to participate in a registry to track the treatments they do and the outcomes. Your doctors will have access to the ongoing data so they can make informed decisions on if the drugs are worth trying or not and in which combinations.
Once enough data is collected, the drug company can ask the FDA for full approval. The bar for this graduation to full approval is the same as the bar for the regular pathway. So once these drugs get full approval, they will have more research behind them than the current treatments have, and we will already know how best to use them.
The bottom line – if this bill passed when we first introduced it, you would have easy access to many different treatments now, as well as the data to help decide which would help you the most.
If you have questions about it – ask here! I helped author the bill – along with many other organizations. We have over 100 foundations supporting the bill. To see the list, look at the one pager on the web page noted above!
To be fair – there is some opposition. If interested, I can talk about it.

Promising Pathway Act 2.0
This bill is going to be introduced in Congress on this Thursday (hopefully). I need everyone’s help in getting it passed. I made a quick and easy way to send letters to your congress people. Just go to https://virtualtrials.org/activism and fill out the form. You can edit the sample letter – explain your connection to brain tumors, or just send it as is.
The bill creates a new pathway to fda approval called conditional approval and a learning system so we can figure out the best way to use these drugs alone and in combinations.
Conditional approval means that once a drug is shown to be relatively safe and early indications that it helps, it gets approved. The bar is basically after a phase 2 trial where there is enough evidence to allow it to move forward into a phase 3 trial. Once it gets conditional approval, your doctor can prescribe it and insurance should pay for it. Then everyone who uses a treatment approved under this pathway has to participate in a registry to track the treatments they do and the outcomes. Your doctors will have access to the ongoing data so they can make informed decisions on if the drugs are worth trying or not and in which combinations.
Once enough data is collected, the drug company can ask the FDA for full approval. The bar for this graduation to full approval is the same as the bar for the regular pathway. So once these drugs get full approval, they will have more research behind them than the current treatments have, and we will already know how best to use them.
The bottom line – if this bill passed when we first introduced it, you would have easy access to many different treatments now, as well as the data to help decide which would help you the most.
If you have questions about it – ask here! I helped author the bill – along with many other organizations. We have over 100 foundations supporting the bill. To see the list, look at the one pager on the web page noted above!
To be fair – there is some opposition. If interested, I can talk about it.

Promising Pathway Act 2.0
This bill is going to be introduced in Congress on this Thursday (hopefully). I need everyone’s help in getting it passed. I made a quick and easy way to send letters to your congress people. Just go to https://virtualtrials.org/activism and fill out the form. You can edit the sample letter – explain your connection to brain tumors, or just send it as is.
The bill creates a new pathway to fda approval called conditional approval and a learning system so we can figure out the best way to use these drugs alone and in combinations.
Conditional approval means that once a drug is shown to be relatively safe and early indications that it helps, it gets approved. The bar is basically after a phase 2 trial where there is enough evidence to allow it to move forward into a phase 3 trial. Once it gets conditional approval, your doctor can prescribe it and insurance should pay for it. Then everyone who uses a treatment approved under this pathway has to participate in a registry to track the treatments they do and the outcomes. Your doctors will have access to the ongoing data so they can make informed decisions on if the drugs are worth trying or not and in which combinations.
Once enough data is collected, the drug company can ask the FDA for full approval. The bar for this graduation to full approval is the same as the bar for the regular pathway. So once these drugs get full approval, they will have more research behind them than the current treatments have, and we will already know how best to use them.
The bottom line – if this bill passed when we first introduced it, you would have easy access to many different treatments now, as well as the data to help decide which would help you the most.
If you have questions about it – ask here! I helped author the bill – along with many other organizations. We have over 100 foundations supporting the bill. To see the list, look at the one pager on the web page noted above!
To be fair – there is some opposition. If interested, I can talk about it.

As prescribed by a doctor, that is.
Adderall/stimulants as a whole are the most effective treatment for ADHD, and it's not even close. Yes, that goes for children as well. It is far, far more fucked up to allow a child to go through their most formative years without access to the treatment that would give them the best shot at living a normal life.
"Older adults with ADHD not receiving childhood stimulant treatment were 3 times more likely to be unemployed than counterparts ... Patients receiving stimulant treatment were less likely than untreated peers to develop major depressive disorder (MDD), anxiety disorder, or disruptive behavior disorder and were less likely to repeat a school grade" (Halmoy et. al, 2009).
Adderall is no more habit-forming than any other medication taken daily as prescribed by a doctor, and there is no compelling evidence that Adderall leads to addiction in those with ADHD. For people with ADHD, Adderall actually lowers risk of drug abuse. If left untreated, those with ADHD are far more likely to self-medicate in a more harmful way.
"Analysis showed that stimulant-treated youth with ADHD were half as likely to develop substance use disorder as those that had not been treated with pharmacotherapy" (Farone et. al., 2007).
"The acknowledged risk of stimulant misuse among patients must be balanced against the direct real-world consequences of poorly managed ADHD during the young adult years (eg, financial problems, arrests, substance use, early pregnancy, low academic achievement), which may endure for decades" (Halmoy et. al, 2009).
Untreated ADHD is consistently shown to have profoundly negative impacts on one's life. It's not just about grades or their ability to focus in school. It affects one's personal relationships, chances at personal success/happiness, emotional development, and overall self-worth. It's one of the most debilitating disorders you can have.
"Medication is effective for treating ADHD symptoms, and studies suggest that earlier identification and treatment may improve longer-term educational, work, and social outcomes" (Felt et al., 2014).
So, here is my plea to any parents reading this: As someone who went undiagnosed and untreated as a child, I absolutely urge you to do your own research and keep an open mind. Don't deny your child the chance at a better life based on unfounded stigma. Trust the science.
H-h-have a good night.

Hi! I’m a 20F (5’4 and 125 lbs) and for the past three years I had a feeling I had a hormonal imbalance. My periods never skipped any month, but they were always late and my cycle length ranges from 25-43 days. I also was having lots of facial and chest hair and hormonal acne on my face. I went to see my primary care doctor and he said I was too skinny, did not have enough facial hair, and did not have bad enough acne to have pcos. I didn’t give up though and went to my college’s student health services and they ran a blood test and my testosterone level was at 150 ng/dL. I then did more lab work and my LH to FSH was at a 1:5 ratio. I also saw a dermatologist who prescribed me sprinolactone for my acne but he said I should use something in addition to it for my pcos. I just need some guidance on what medications or what I should try doing. I don’t think I have insulin-resistant pcos because my blood sugar was not high and I don’t have any weight issues. My question is, would birth control really help in my case where I have lean pcos? Or could something like metformin also help? Any advice is very appreciated :)

Just went to Capalaba Central Doctors in Brisbane for prescription. I've been on HRT for years and had no troubles being prescribed it by my previous doctor. I had a consult with this capalaba doctor who wanted to charge $90 to turn me away and say "I am not comfortable with providing services to transgender people". I asked why and they couldn't give me an answer, but bombarded me with questions like "how long has your other doctor been practising for, why did you stop going" to which I said I don't drive as I don't have a license and he blamed me for my inability to go to a doctor 45 minutes away since moving houses. I asked to see an other doctor and the receptionist were kind and understanding yet the second doctor told me he does not want to prescribe it and if I wanted these medications I should be seeing a "white doctor, female doctor or an asian- specifically Thai doctor," which I assume is because of their lady boy population. At first he tried to tell me he doesn't do this on first consult however we signed a form which stated the medications they will not prescribe on first consult and this was not one, to which he said he doesn't know much about it, though I'm at the maximum dosage and all I need is prescriptions. They were extremely rude and wouldn't let me explain my situation at all.

In 2016, I started having severe heartburn. Nothing too abnormal, except I was in my young twenties.
Then, extreme fatigue. As in, I would sleep for three days in a row, awake for 1-3 hours before falling asleep again under the feeling of being weighed down.
White tongue started five years ago.
Then, within the last couple years, stomach tightness and cramping.
I've seen a doctor about five times. First time, they prescribed anti-anxiety medicine. What???? Second time, told me to take tums. Third time, they prescribed a pharmaceutical anti-acid.
When does acid reflux causes someone to sleep 60-68 hours in a 72 hour period?
Also, acid reflux is no longer a symptom of mine. They don't even seem to listen when I go to the hospital. They see a young face, a thirty year old who looks twenty, and think it must be psychological. Fourth time, they told me to have a glass of wine and relax for the evening. Is not being able to leave bed relaxed enough? I usually go to the hospital after three days in bed, once I've rested enough and drank enough bone broth to have the energy to drive. In other words, this isn't an acute anxiety attack.
30 Male Idaho, United States

Hi Im hoping to get some information for my mom (mid 60s), and maybe to rant a little. She was diagnosed with AFIB (hers is the kind with slower than avg heartrate) after an urelated hospital stay in 2021, later managed with medication.
She started seeing an AFIB specialist who encouraged her to try to get off medicinally managing rhythm and suggested an ablation. She got her first one about a year and a half ago and was doing good without any episodes until about 6 months ago. Even when not in AFIB these last few months shes had swelling and redness of her ankles and feet causing mobility problems.
She went in for her second ablation (which the doctor did warn us was more than likely what she would need, so we were prepared for it) May 8. She was prescribed lasix post-op this second time (I dont remember if she had it the first time too), and had great improvement of the swelling/pain in her ankles and feet. She had her first episode of afib this saturday (may 17- the day after her last dose of lasix) and had another one today (may 20). The only new thing of note is when the dr. called me after surgery he noticed she had left arterial enlargement and scarring compared to last time.
I am feeling frustrated and scared the second ablation didnt appear to help at all on top of the concerning symtoms and enlargement, and im sure my mom is too. Her follow up with the AFIB specialist isnt until june. Has this happened to anyone else? Is getting off flecainide just not going to happen in cases like hers?
She also needs to find a new regular cardiologist, even more so with the enlargement, so we are trying to do that. If anyone has any recommendations in the Bryan/College Station area, or we are willing to travel to Temple or Houston for the right person (last cardiologist suggested tackling weight loss and thus mobility improvement by just drinking coffee whenever she was hungry...ok great).
Any words of encouragement or resources i can share with her to figure out what her triggers are I would appreciate it.

The heart burn was manageable. The symptoms that made it unbearable are the hyper salivation (water brash) and difficulty swallowing. I was also vomiting 30 mins to an hour after every meal. I would often gag on my excess saliva trying to bring it down since I cant always spit it out (in a meeting at work, getting a haircut, etc) It was prevalent for years but the last couple of years it has gotten way more severe and excessive. Symptoms are more severe in the morning after waking up from laying down from sleep.
Last year I told my doctor and she prescribed me a PPI i took it for a few days and it did nothing. a year later it gets worse and then my doctor had me go get a endoscopy. I was diagnosed with esophagitis and the doctor who did my endoscopy prescribed me a PPI called dexilant. I have also made lifestyle changes this time. Quit all sources of caffeine (including my #1 drink Coke Zero) Went from smoking a joint every day to an average of once a week and use edibles if i I really need to get high. I still have spicy food but I don't go overly crazy. I drink some table spoons of aloe juice.
I have been on the PPI and new lifestyle for 2 weeks and allthough my symptoms are still here and sometimes pretty bad I have noticed a noticable decrease in occurrence. When I am walking down the street I am not constantly spitting saliva anymore. I havent had heart burn since I started the PPI. I still vomit saliva in the morning but it is less severe and I no longer vomit after eating.
Anyone have any advice for me?

18, female, 5'6, 105 lbs, white, i don't do any drugs, smoke, or use any recreational drugs .
diagnosis : chronic esophagitis, esophageal ulcers, dysphagia, odynophagia, gastric foveolar metaplasia, and acid reflux?
i would appreciate any and all advice from anyone who has any ounce of medical experience or knowledge. i am at a loss and i really need help from anyone. right now, it is hard to find someone who can help me, hence why i am here.
i struggle with difficulty swallowing and feeling like someone is squeezing my esophagus when i swallow. some days it has gotten to a point where i can't swallow water. i've done 2x upper endoscopies and 2 different hospitals in the span of 3 yrs. the first one can back with esophageal damage, prescribed omeprazole, the second one, done last week, came back with a lot of "issues" not a lot of results. i say i have gerd but i wasn't diagnosed. even my doctor said i don't have the "traditional" symptoms. my problem is they found nodules, ulcers, inflamation, whatever, and they are still telling me to take antiacids, the same antiacids which allowed for my condition to worsen! they looked for eoe, they looked for celiac, but apparently nothing! the endoscopy doctor said nothing looked "overly concerning" in my endoscopy, but i am still in pain! like i said, i don't experience "acid reflux" but i get the feeling of tightness in my chest when swallowing, almost like something is stuck. i try to cough or burp but little to no relief..
this isn't that relevant but, i honestly don't have any motivation to eat anymore. it has gotten to be such a painful burden for me. i have lost weight but i see no motivation in eating when it is so difficult for me especially if i don't enjoy the food. i want to enjoy eating without feeling pain. i am willing to post endoscopy images if needed. i just don't know what steps i should take now. follow up with the doctor? ask them for different medicine? i don't know. thank you friends for help.
** all of the diagnosis i put up top were just from my last endoscopy last week**