Brewers @ Royals - Tue, May 07

Game Status: Game Over - Score: 6-5 Brewers

Links & Info

• MLB Gameday
• Game Graphs
• Savant Gamefeed

	Brewers Batters	AB	R	H	RBI	BB	K	LOB	AVG	OBP	SLG
1	Frelick - RF	3	0	1	0	0	0	0	.250	.328	.308
	a-Monasterio - LF	2	0	1	1	0	0	0	.091	.231	.091
2	Contreras, Wm - C	5	1	2	0	0	0	2	.331	.406	.511
3	Black - DH	3	0	1	0	0	1	2	.227	.261	.318
	b-Sánchez - DH	1	1	0	0	1	1	2	.208	.288	.491
4	Adames - SS	4	1	1	3	1	1	0	.257	.346	.463
5	Turang - 2B	5	0	2	0	0	0	2	.301	.365	.407
6	Hoskins - 1B	5	1	1	1	0	1	2	.218	.324	.437
7	Ortiz - 3B	3	1	1	1	0	2	0	.268	.384	.465
	Bauers - RF	1	0	1	0	0	0	0	.206	.270	.368
8	Chourio - LF	3	0	1	0	0	0	0	.225	.269	.351
	c-Dunn - 3B	1	0	0	0	0	1	2	.227	.266	.333
9	Perkins, B - CF	4	1	1	0	0	1	1	.257	.359	.416
	Totals	40	6	13	6	2	8	13

Brewers
a-Singled for Frelick in the 7th. b-Struck out for Black in the 7th. c-Struck out for Chourio in the 8th.
BATTING: 2B: Contreras, Wm (10, McArthur). HR: Hoskins (7, 2nd inning off Lugo, S, 0 on, 0 out); Ortiz (2, 2nd inning off Lugo, S, 0 on, 0 out); Adames (7, 9th inning off McArthur, 2 on, 2 out). TB: Adames 4; Bauers; Black; Chourio; Contreras, Wm 3; Frelick; Hoskins 4; Monasterio; Ortiz 4; Perkins, B; Turang 2. RBI: Adames 3 (25); Hoskins (19); Monasterio (1); Ortiz (9). 2-out RBI: Adames 3; Monasterio. Runners left in scoring position, 2 out: Dunn; Black; Sánchez; Turang. Team RISP: 2-for-7. Team LOB: 9.

	Royals Batters	AB	R	H	RBI	BB	K	LOB	AVG	OBP	SLG
1	Garcia, M - 3B	5	0	1	0	0	1	1	.234	.289	.372
2	Witt Jr. - SS	4	2	2	0	1	0	1	.319	.385	.542
3	Pasquantino - 1B	5	1	3	3	0	0	1	.238	.333	.410
4	Perez, S - C	4	0	1	1	0	2	3	.326	.387	.558
5	Massey - 2B	4	0	1	0	0	1	3	.291	.304	.509
6	Renfroe - RF	4	0	0	0	0	0	2	.155	.219	.278
7	Melendez - DH	4	1	1	0	0	2	0	.185	.248	.370
8	Velázquez - LF	4	0	1	0	0	0	1	.214	.287	.337
	Hampson - LF	0	0	0	0	0	0	0	.222	.243	.250
9	Isbel - CF	4	1	2	1	0	1	1	.225	.262	.363
	Totals	38	5	12	5	1	7	13

Royals
BATTING: 2B: Pasquantino (9, Rea); Perez, S (6, Rea). 3B: Melendez (1, Rea). TB: Garcia, M; Isbel 2; Massey; Melendez 3; Pasquantino 4; Perez, S 2; Velázquez; Witt Jr. 2. RBI: Isbel (10); Pasquantino 3 (21); Perez, S (31). 2-out RBI: Perez, S; Pasquantino 2. Runners left in scoring position, 2 out: Massey 2; Renfroe. Team RISP: 5-for-10. Team LOB: 7.
FIELDING: E: Garcia, M (3, throw).

Brewers Pitchers	IP	H	R	ER	BB	K	HR	P-S	ERA
Rea	4.2	7	4	4	1	2	0	65-45	3.29
Milner	1.1	1	0	0	0	3	0	22-15	2.20
Vieira	0.2	2	1	1	0	1	0	15-11	5.71
Koenig (W, 3-1)	1.1	2	0	0	0	0	0	19-12	3.18
Megill (S, 3)	1.0	0	0	0	0	1	0	8-8	1.04
Totals	9.0	12	5	5	1	7	0

Royals Pitchers	IP	H	R	ER	BB	K	HR	P-S	ERA
Lugo, S	6.2	6	3	3	1	5	2	77-54	1.92
Zerpa (H, 5)	0.1	2	0	0	0	1	0	13-8	1.72
Schreiber (H, 9)	1.0	2	0	0	0	2	0	27-19	1.04
McArthur (L, 1-2)(BS, 3)	1.0	3	3	3	1	0	1	30-19	4.32
Totals	9.0	13	6	6	2	8	3

Game Info
Pitches-strikes: Rea 65-45; Milner 22-15; Vieira 15-11; Koenig 19-12; Megill 8-8; Lugo, S 77-54; Zerpa 13-8; Schreiber 27-19; McArthur 30-19.
Groundouts-flyouts: Rea 7-2; Milner 0-1; Vieira 1-0; Koenig 1-1; Megill 1-1; Lugo, S 8-5; Zerpa 0-0; Schreiber 0-0; McArthur 1-1.
Batters faced: Rea 22; Milner 5; Vieira 4; Koenig 5; Megill 3; Lugo, S 27; Zerpa 3; Schreiber 5; McArthur 7.
Inherited runners-scored: Milner 1-0; Koenig 1-0; Zerpa 1-1.
Umpires: HP: Emil Jimenez. 1B: Todd Tichenor. 2B: Angel Hernandez. 3B: Nic Lentz.
Weather: 77 degrees, Clear.
Wind: 14 mph, R To L.
First pitch: 6:40 PM.
T: 2:32.
Att: 14,657.
Venue: Kauffman Stadium.
May 7, 2024

Inning	Scoring Play	Score
Top 2	Rhys Hoskins homers (7) on a fly ball to center field.	1-0 MIL
Top 2	Joey Ortiz homers (2) on a fly ball to left center field.	2-0 MIL
Bottom 5	Kyle Isbel singles on a line drive to left fielder Jackson Chourio. MJ Melendez scores.	2-1 MIL
Bottom 5	Vinnie Pasquantino doubles (9) on a sharp line drive to center fielder Blake Perkins. Kyle Isbel scores. Bobby Witt Jr. scores.	3-2 KC
Bottom 5	Salvador Perez doubles (6) on a sharp line drive to left fielder Jackson Chourio. Vinnie Pasquantino scores.	4-2 KC
Top 7	Andruw Monasterio singles on a ground ball to right fielder Hunter Renfroe. Blake Perkins scores.	4-3 KC
Bottom 7	Vinnie Pasquantino singles on a ground ball to center fielder Blake Perkins. Bobby Witt Jr. scores.	5-3 KC
Top 9	Willy Adames homers (7) on a fly ball to left field. William Contreras scores. Gary Sánchez scores.	6-5 MIL

Team	Highlight
MIL	Rhys Hoskins' solo home run (7) (00:00:22)
MIL	Joey Ortiz' solo home run (2) (00:00:26)
MIL	Hoskins and Ortiz go back-to-back (00:00:49)
KC	Vinnie Pasquantino's two-run double (00:00:30)
KC	Salvador Perez's RBI double (00:00:31)
MIL	Andruw Monasterio's RBI single (00:00:18)
KC	Vinnie Pasquantino's RBI single (00:00:28)
MIL	Colin Rea K's two across 4 2/3 innings (00:00:16)
KC	Garcia's leaping catch (00:00:14)
MIL	Willy Adames' go-ahead home run (7) (00:00:28)

	1	2	3	4	5	6	7	8	9		R	H	E	LOB
Brewers	0	2	0	0	0	0	1	0	3		6	13	0	9
Royals	0	0	0	0	4	0	1	0	0		5	12	1	7

Decisions

• Winner: Jared Koenig (3-1, 3.18)
• Loser: James McArthur (1-2, 4.32)
• Save: Trevor Megill (3, 1.04)

Division Scoreboard

DET 11 @ CLE 7 - Final
CWS 1 @ TB 5 - Final
SEA 6 @ MIN 6 - End 8
Next Royals Game: Wed, May 08, 01:10 PM CDT vs. Brewers
^{Last Updated: 05/07/2024 09:19:06 PM CDT}

I’ve dropped down to 40 mg from 60 mg (prior to that 80 mg) with good results, although I’m noticing I feel a couple of ADHD symptoms returning, particularly in the morning just before my next dose.
Is anyone on 50 mg permanently? Ideally I’d rather not be, because it’ll be twice as expensive long term, but I’d be curious to see if it helped without having the unpleasant side effects of 60 mg. I’m pretty sensitive to atomoxetine.

I'm 38M, 179cm tall, 80.2kg, white. Primary complaints are abdominal pain, constipation, fatigue, and dermatitis.
Currently use nicotine (vaping about 2/3 of a 1.8% Vuse cartridge a day). Currently take a multivitamin and magnesium. Occasional light cannabis use, and that's it at the moment. No current alcohol use. I take Miralax most days.
This has been a long road, and I fortunately have a new primary care physician and am getting a referral to a GI doctor. Hopefully I can get some answers.
I have been a nicotine user since 19 years old, switched to vaping about 3 years ago. I was a heavy kratom user from about 2016 to 2023, and have since kicked that habit. I was a light drinker, but have completely abstained from alcohol for over a year.
About 10 years ago, I noticed I was getting a lot of heartburn, and ignored it/took Tums as necessary. It got really bad when my kratom use started getting heavy. Since I quit kratom, it has mostly gone away.
I did have COVID in Feb 2022.
Anyway, in January 2023, I started getting REALLY constipated. I ended up not going for about a month, and went to the ER when stool softeners, laxatives, and enemas failed. A CT was performed, which showed a "moderate" stool load, and fatty infiltration of my pancreas. Lipase was slightly low at 12, I believe. I have read that kratom consumption can lower serum lipase levels. The ER I went to was really obvious that they thought I was drug seeking, and sent me home saying to keep taking Miralax and go to a GI doctor (4 months later).
Fortunately, the constipation magically resolved, and I was doing pretty well, but I noticed when the abdominal pain would flare up, I would get really bad dermatitis on my scalp, face, and fingers of my right hand. Constipation would come back, and go away. My primary care doc at the time ended up doing an upper abdominal ultrasound. This showed the same fatty infiltration of my pancreas, and several <6mm polyps in my gallbladder. Otherwise normal.
I was having a lot of side effects from the kratom, so I started tapering off that July. As soon as I did, I started having bad upper abdominal pain/cramping. This continued until now. The GI doctor pretty much wrote it off as IBS, then when I saw him again he said it might be pancreas, but the guy was a jerk (I couldn't get a word in to describe my symptoms). Evidently, I'm not the only person, as I have talked to two other people that said the same about that clinic.
So, since I was getting really fed up with that particular medical group, I didn't go back to them. I tried changing my diet in a myriad of different ways, with minimal results. Lost 40 pounds from my change in diet (I was obese, but no longer). Started noticing mucous in my stool. Lots of changes from day to day in my stool. Sometimes it's Bristol 2 or Bristol 6. Sometimes it's 1/2 inch diameter or 2 inch diameter. Sometimes it's tiny amounts or a huge volume. Very rarely has it been yellowish or floated. Usually it's medium brown. No visible blood.
The constant abdominal pain has made it hard for me to do anything outside of going to work and coming home. Some days it's horrible. I never have a fever, nausea, vomiting.
I took it upon myself to get some blood and stool tests this year to rule things out:

• CMP/CBC/UA: All totally normal and within reference range.
  
• H. Pylori breath test: Negative.
  
• Lyme disease: No antibodies.
  
• Syphilis: No antibodies.
  
• HIV: Nope.
  
• Fit test: No blood.
  
• Stool microscopy: No helminths or ova. A small amount of candida.
  
• Blood food allergy test: Mildly allergic to sesame, nothing else on the panel.
  

Then, I had an ANA run via Quest Diagnostics. At 1:80, it came back positive with a nuclear pattern, dense fine speckled. At 1:320, it came back positive with "few nuclear dots". The antibody panel it reflexed to was completely negative. Quest called me and said "get to a doctor."
So, my insurance changed and I could go outside the medical group I hated! I recently scheduled an appointment with a new PCP. He wanted to re-run the ANA, but through Labcorp.
That ANA came back as follows: At 1:80, positive with a homogenous pattern (AC-1), and a speckled pattern (AC-2,4,5,29). At 1:160, positive with a nuclear dot pattern (AC-6,7). Again, the antigen panel was negative.
I had also recently been noticing my tongue is white. I just went to the dentist, and she said that she's not concerned enough to biopsy, but we need to monitor it, and it may be from a nutrient deficiency.
I've been trying to supplement, but my iron consumption has been low, so I'm reintroducing beef to my diet.
Still waiting to get in to the new GI doctor.
Anyway, I'm not sure what to think. When my guts hurt, it feels like food/stool moves to a spot, and just stops and cramps. Then, 12 hours to 2 days later, it suddenly moves again, and gets stuck somewhere else. There are certain foods I'm not allergic to but can't tolerate at all (peanuts, sunflower, others). It doesn't seem to be related to fat content, though. I can eat fatty foods as long as they don't have peanut or sunflower oil. Wheat seems to be another trigger, but it's not exclusive (because I didn't have any for over 6 months and still had problems).
When I'm having BAD abdominal pain, my skin on my face and right hand flakes and itches. It can get bad. My phalanges on both hands have shiny skin, too. And the fatigue is terrible. This made me very sedentary, but lately I've been forcing myself to walk, shooting for about 10k steps per day. It's difficult. Also during bad flareups, my eyes get veiny/red, and my cheeks get flushed (sometimes my whole face). People tell me I look sunburned sometimes.
I am really suspecting my immune system is involved here, but don't know where to look. Maybe I just wait for the GI appointment. Maybe I encourage my new PCP to send me to rheumatology.
What's super weird, is that my (recently ex) wife was having almost identical symptoms, for about 2 years, 2 years prior to this starting with me. She got a similar runaround with doctors, told it was in her head, told they couldn't figure it out, etc. It started resolving on its own. That said, my symptoms are worse than hers. I'm honestly really concerned about my future at this point, because it's hard to function day-to-day.
Off the top of my head, I'm thinking systemic sclerosis (but I'd think there'd be positive antigens on the ANA reflex), or some kind of autoimmune cholangitis, or a mast cell disorder. Or a lymphoma. Whatever it is, it's scary.

I just recently started taking stimulants after failed attempts with nonstimulants, but I took some Ritalin after eating and I just feel so mellowed out and calm, I feel like my anxiety has been decreased and I feel less fidgety. I feel like all I want to do today is just sit at my desk in silence, like not in a lazy way, but like I just feel way too relaxed right now. Like I don't even have the need to open my phone right now. Has anyone experienced this? I was kind of expecting a jolt of energy but in reality I'm just really relaxed and even my heart rate is reduced.
Right now it is still difficult to focus, but like I just feel relaxed, and it kind of feels refreshing and good!

In 1989 my wife gave me an Odysseus and within a few months I lost it. This week I found it in the bottom of an old chest. The battery has been in there for 35 years and most likely damages the movement. If it does need a new movement. How much am I looking at?

Angels (13-23) @ Pirates (17-20)

First Pitch: 3:40 PM at PNC Park

Team	Starter	TV	Radio
Angels	Patrick Sandoval (2-5, 4.85 ERA)	BSW	KLAA
Pirates	Quinn Priester (0-3, 3.86 ERA)	SNP	KDKA

Game Preview
/angelsbaseball Discord
Reddit Stream for this post

Line Score - Game Over

	1	2	3	4	5	6	7	8	9	R	H	E	LOB
LAA	0	0	0	3	2	1	1	2	0	9	15	1	10
PIT	0	0	0	0	0	0	0	0	0	0	3	1	4

Box Score

PIT		AB	R	H	RBI	BB	SO	BA
DH	McCutchen	4	0	1	0	0	1	.189
LF	Reynolds, B	3	0	0	0	0	1	.245
LF	Suwinski	1	0	0	0	0	0	.175
3B	Hayes	4	0	0	0	0	0	.240
1B	Joe	3	0	1	0	0	2	.280
PH	Tellez	1	0	0	0	0	1	.209
RF	Olivares	3	0	1	0	0	0	.222
C	Grandal	2	0	0	0	1	0	.111
2B	Triolo	3	0	0	0	0	2	.216
CF	Taylor, M	3	0	0	0	0	1	.221
SS	Williams	3	0	0	0	0	0	.256

PIT	IP	H	R	ER	BB	SO	P-S	ERA
Priester	4.2	7	5	3	2	1	74-48	3.86
Contreras	2.1	5	2	2	0	3	44-33	4.70
Fleming	1.0	3	2	2	1	2	28-19	3.18
Nicolas	1.0	0	0	0	0	0	10-7	0.00

LAA		AB	R	H	RBI	BB	SO	BA
1B	Schanuel	6	1	2	1	0	0	.239
CF	Moniak	5	2	2	0	0	1	.198
2B	Drury	5	0	1	0	0	2	.158
DH	Calhoun, W	3	3	1	0	2	0	.368
LF	Pillar	5	2	3	6	0	0	.222
C	O'Hoppe	5	0	4	2	0	0	.279
RF	Adell	5	0	1	0	0	2	.247
3B	Tucker	4	0	0	0	1	0	.278
SS	Neto	5	1	1	0	0	1	.238

LAA	IP	H	R	ER	BB	SO	P-S	ERA
Sandoval	7.0	3	0	0	1	7	103-71	4.85
García, L	1.0	0	0	0	0	0	8-5	5.14
Estévez	1.0	0	0	0	0	1	14-9	5.59

Scoring Plays

Inning	Event	Score
T4	Kevin Pillar homers (2) on a fly ball to left field. Mickey Moniak scores. Willie Calhoun scores.	0-3
T5	Kevin Pillar grounds into a force out, fielded by third baseman Ke'Bryan Hayes. Mickey Moniak scores. Brandon Drury out at 3rd. Willie Calhoun to 2nd. Kevin Pillar to 1st.	0-4
T5	Logan O'Hoppe singles on a ground ball to left fielder Bryan Reynolds. Willie Calhoun scores. Kevin Pillar to 2nd.	0-5
T6	Nolan Schanuel singles on a line drive to right fielder Edward Olivares. Zach Neto scores.	0-6
T7	Kevin Pillar homers (3) on a fly ball to left field.	0-7
T8	Kevin Pillar doubles (3) on a line drive to center fielder Michael A. Taylor. Nolan Schanuel scores. Willie Calhoun to 3rd.	0-8
T8	Logan O'Hoppe singles on a ground ball to third baseman Ke'Bryan Hayes. Willie Calhoun scores. Kevin Pillar to 3rd.	0-9

Highlights

Description	Length
Bullpen availability for Pittsburgh, May 7 vs Angels	0:07
Bullpen availability for Los Angeles, May 7 vs Pirates	0:07
Bench availability for Pittsburgh, May 7 vs Angels	0:07
Fielding alignment for Pittsburgh, May 7 vs Angels	0:11
Bench availability for Los Angeles, May 7 vs Pirates	0:07
Fielding alignment for Los Angeles, May 7 vs Pirates	0:11
Starting lineups for Angels at Pirates - May 7, 2024	0:09
Breaking down Kevin Pillar's home run	0:12
Breaking down Quinn Priester's pitches	0:04
Breaking down Kevin Pillar's home run	0:12
Breaking down Patrick Sandoval's pitches	0:04
Patrick Sandoval's outing against the Pirates	0:23
Kevin Pillar's three-run homer (2)	0:30
Kevin Pillar's RBI fielder's choice	0:23
Logan O'Hoppe's RBI single	0:19
Quinn Priester strikes out Brandon Drury	0:07
Nolan Schanuel's RBI single	0:18
Kevin Pillar's second homer of the game (3)	0:30
Patrick Sandoval stays in, ends 7th with strikeout	0:31
Kevin Pillar's RBI double	0:16
Logan O'Hoppe's RBI single	0:24
Patrick Sandoval's seven scoreless innings	1:04

Decisions

Winning Pitcher	Losing Pitcher	Save
Sandoval (2-5, 4.85 ERA)	Priester (0-3, 3.86 ERA)

Game ended at 6:33 PM.

The link between Post-SSRI Sexual Dysfunction, Hard Flaccid Syndrome, Post Finasteride Syndrome, Pelvic Floor Dysfunction, Chronic Pelvic Pain Syndrome and advice on how to start your healing journey based on 8 years of research and personal experiences : pssdhealing (reddit.com)
Here are all my thoughts and advice based on my personal experiences, other people’s insight and helpful experiences, and research I have done on and off about pelvic floor issues from the past eight years or so. I am not claiming that any of this is revolutionary, but I hope it can help some of you out there to give you a head start on healing and advance our understanding of these conditions. As I am a 27 year old male with previous major problems with pelvic floor issues and hard flaccid, some of my advice may be biased towards my condition. However, I believe everyone can benefit from a lot of this because I really do think that all of these conditions that I mentioned are linked in at least some way, especially by pelvic floor dysfunction and sex hormone desensitization. I try not to come to these forums because it increases anxiety and negative emotions which leads to worse pelvic floor symptoms, so my apologies if I do not respond to your questions. For hard flaccid and pelvic floor affected people, follow my advice and I am confident you can heal and reach a place where your symptoms barely affect your life, if at all, which is where I am at now. The mentality of trying to find a 100% “magic cure” solution just leads to anxiety and catastrophic thinking if you have a set back which will only worsen your symptoms. You can and will heal. I know this is a lot of information, but try to implement just one or two things at a time. Focus on the present, and take it one day at a time. Don’t get overwhelmed. All of this is my opinion and not professional medical advice. Talk with your doctor before starting anything.
Post Finasteride Syndrome (PFS), Post-SSRI Sexual Dysfunction (PSSD), Hard Flaccid Syndrome (HFS), Pelvic Floor Dysfunction, and Chronic Pelvic Pain Syndrome all can have some similar symptoms. I believe that they are all either caused or can be exacerbated by androgen and estrogen receptor insensitivity and are triggered by medication, genital injury, and pelvic floor inflammation and dysfunction. The pelvic floor is rich in androgen receptors and estrogen receptors. However, without proper androgen receptor activation and sensitivity, the pelvic floor muscles don’t have enough DHT which line the tissues of the pelvic floor, genitalia, and lower urinary tract. DHT is vital for healthy sexual functioning in both sexes - it provides an anabolic effect to tissues to provide strength, stability, healing, and relaxation to tissues. As a result of androgen receptor insensitivity and lack of DHT, the pelvic floor can become chronically weakened, tight, and inflamed which reduces blood flow to the region leading to even more androgen receptor insensitivity and thus less DHT. These symptoms can cause psychological stress to the individual which tightens the pelvic floor further leading to more symptoms and less blood flow. One study found that androgen sensitivity has raised the possibility that androgens can be used to rebuild the weakened and/or damaged muscles comprising the pelvic floor - source. Some people may also have normal hormone levels in the blood when tested, but these hormones cannot reach or be effective in the pelvic floor tissues or brain due to sex hormone insensitivity and the lack of the blood flow in the region caused by pelvic floor tightness and dysfunction. It is also likely that there is a problem with desensitized estrogen receptors causing a similar mechanism of dysfunction because they are also found in the pelvic floor, genitals, and brain and are important for pelvic floor health, sexual functioning, cognition, and emotions in both sexes. The most important element to remember to help start the healing process for these disorders is to boost blood flow through supplements, stretches, and exercises which will increase both androgen and estrogen receptor sensitivity over time.
Many males with PFS, PSSD, and Pelvic Floor dysfunction are affected by the hard flaccid condition.
Post Finasteride Syndrome (PFS) caused by Finasteride, a 5-alpha-reductase inhibitor (5-ARI), plummets DHT levels in the body to try to help hair loss causing sexual dysfunction and pelvic floor issues. Androgen receptors that surround the pelvic floor, genitals, and brain become desensitized due to the Finasteride leading to less DHT binding to these receptors causing dysfunction and a tight, weak pelvic floor. The tight, dysfunctional pelvic floor now restricts blood flow which impacts healing and the delivery of testosterone to this area that further exacerbates androgen insensitivity leading to less DHT in these tissues. Since androgen receptors are found in the brain and androgens have neuroprotective effects, this could be one reason why some PFS and PSSD sufferers are also impacted cognitively. An herbal supplement called Saw Palmetto has also been reported to cause a disorder similar to PFS because it is also a 5-ARI that blocks the conversion of testosterone into DHT. Another disorder called Post Accutane Syndrome (PAS) is also similar to PFS and it reduces DHT as well through being a 5-ARI: “Isotretinoin, used to treat severe acne, has been shown to induce hormonal changes, especially to reduce 5 alpha-reductase in the production of the tissue-derived dihydrotestosterone (DHT) metabolite 3 alpha-Adiol G.”. PFS, PAS, and PSSD are thought to cause not only androgen receptor desensitization, but likely estrogen receptor desensitization as well.
For Post-SSRI Sexual Dysfunction (PSSD), SSRIs are also known to decrease androgens and down regulate androgen receptors. This study shows that SSRIs can have an anti-estrogenic effect as well and can even reduce the expression of estrogen receptors (ER), including in the hypothalamus.. As sex hormones get desensitized in the pelvic floor, genital region, and brain, it causes localized DHT and estrogen levels in these tissues to decrease causing emotional blunting, sexual dysfunction, pelvic floor issues, hard flaccid syndrome, and more. The pelvic floor dysfunction can then prevent the sex hormone receptors from being reactivated and sensitized due to restricting oxygen and sex hormone rich blood flow to the tissues. SSRIs can cause androgen receptor insensitivity and estrogen receptor insensitivity by severely inhibiting the serotonin transporter (SERT) leading to increased serotonin levels which desensitizes those receptors throughout the body. One key to help heal from PSSD is increasing androgen production, androgen receptor sensitivity, and blood flow to boost BDNF, SERT, and DHT levels to hopefully allow any estrogen receptor desensitization recover on its own over time after everything else is normalized. Once androgen levels in local tissues (pelvic floor, brain, genitals) are normalized again through androgen receptor activation and sensitivity, it will encourage the conversion of androgens into estrogens in these tissues via aromatase. It is also worth to mention that some community members are trying to restore estrogen receptor sensitivity via boosting estrogen in various ways including by taking hops extract which is a potent phytoestrogen. This is also interesting: Estradiol represents another important natural ligand for androgen receptors that may play an essential role for the androgen receptor function and the development of the male reproductive system.
As mentioned earlier, people with PSSD and other disorders might have normal looking hormone blood tests (testosterone, DHT, estrogen, etc), but the issue is that these hormones are not functioning in the brain, pelvic floor, and genitals properly due to androgen and estrogen receptor insensitivity. An important thing to also recognize is that the medical community still has no official explanation how exactly SSRIs cause all of these debilitating side effects, but they are still being readily prescribed without informed consent about the risks of PSSD. It is unfortunate that it is people like us on the internet leading the charge to investigate and inform. We all need to continue to do our part to spread awareness of these iatrogenic disorders to warn people about the risks of taking these medications because their medical providers aren’t likely going to. Thank you to the PSSD Network for helping to give a voice to the unheard.
Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors
Androgen receptor (AR) inactivation in mice led to reduction in hypothalamic neural nitric oxide synthase (nNOS), indicating the regulatory sexual function of this neurotransmitter. Furthermore, activation of the pre and post-synaptic 5HT1A receptors was found to be correlated with inhibitory effect on erectile function. All of these factors are speculated to be involved in this symptom and might be related to epigenetic alteration of androgen receptor (AR) and estrogen receptor (ER) densities due to influence of SSRIs on the epigenome.
In male PSSD sufferers, the penile shaft can be rigid during erection, yet the glans of the penis remains flaccid.This symptom may arise from hypo-activation of the dopaminergic and oxytocinergic pathways. The glans of the penis, in particular, receives its blood supply from the deep dorsal artery. Perhaps this points to a selective arterial malfunction relative to pelvic floor dysfunction which usually accompanies PSSD.
Here is another interesting study that gives support to the importance of increasing blood flow to help heal:
If SSRIs produce sexual side effects by impairing vasocongestion to the genital region, it would be expected that pharmacologic agents that increase blood flow to the genital region would improve sexual functioning. Indeed, several anecdotal reports and studies have found that sildenafil (a drug designed to treat erectile failure by increasing blood flow into the penile tissue) was successful in reversing SSRI-induced sexual dysfunction in both men and women [8,9,87,88,109]. Sildenafil acts to increase blood flow into the genital tissue by facilitating c-GMP activity that is initiated by nitric oxide [19] and preliminary evidence suggests that the SSRIs may cause sexual difficulties by inhibiting nitric oxide synthase [39,118].
Here is a paper from a community member that hypothesizes that the main issue is lasting estrogen receptor insensitivity just to give another interesting perspective on Post-SSRI Sexual Dysfunction, Post-Finasteride Syndrome, and Post-Retinoid Sexual Dysfunction
As the body is starved of DHT, ARs upregulate in response. At the same time, ER activation is significantly increased as a result of the increased production of Estradiol during treatment (due to higher Testosterone availability by reduced 5a reduction to DHT) - eventually leading to ER downregulation.
Hard Flaccid Syndrome (HFS) - There are many men suffering from HFS and pelvic floor issues due to PSSD, PFS, heavy weight lifting, excess kegeling, or in the case I’m presenting here, physical damage to the genitals from excessive, vigorous sexual activity (my case) or penis enlargement exercises. When the genitals get damaged, an inflammatory process starts and the pelvic floor contracts to protect itself. Since the pelvic floor is now in a chronic, contracted state, it limits oxygen and sex hormone rich blood flow to the genitals and pelvic floor which leads to sex hormone insensitivity and negatively impacts healing, muscle relaxation, and DHT production in these tissues. Finasteride, Accutane, and SSRIs also desensitize sex hormone receptors in the genitals and pelvic floor tissues leading to hard flaccid and pelvic floor dysfunction. Since the pelvic floor tightness restricts blood flow, it is difficult for hard flaccid sufferers to reactivate and sensitize their pelvic floor muscle androgen receptors again to regain relaxation and strength in their pelvic floor muscles, including the ischiocavernosus (IC), bulbocavernosus (BC), and pubococcygeus (PC) which are in a contracted state; the IC muscle in particular is thought to be the most implicated in the cause of hard flaccid. We first need to promote relaxation in the pelvic floor by boosting blood flow through supplements and stretches because tight muscles are weak muscles. Once the pelvic floor is in a chronic state of tension, it is hard to heal from pelvic floor issues because you likely already had bad habits such as poor posture, unhealthy sexual practices, stiff muscles, sedentary lifestyle, unchecked anxiety, and other negative lifestyle factors. Along with supplements, exercises, and stretches, correcting these bad habits is necessary to heal to have an even healthier pelvic floor than you ever had before because it likely was already tight and dysfunctional to begin with before developing obvious issues, but it was more subtle and you had no awareness of your pelvic floor muscles until now. You have the potential to now become a much healthier person overall than you ever would have been without being affected by pelvic floor dysfunction and hard flaccid.
32% of women will develop a pelvic floor disorder in their lifetime which is double that of men. While childbirth and pregnancy plays a role in this discrepancy, women also have far less testosterone and DHT levels than men which I believe plays a major factor. Since women have less testosterone, their androgen receptors that line the pelvic floor don’t make enough DHT to adequately support these tissues compared to men. This makes them more prone to pelvic floor dysfunction that causes them a disparate amount of pain, tightness, and inflammation. Androgen receptors and their ability to convert testosterone into DHT play such a vital role in pelvic floor health and sexual functioning. This is mentioned in a research study: Prevailing scientific literature has indicated the presence of androgen receptors in the levator ani muscle and pelvic fascia. The existence of androgen receptors in the vaginal wall can play an essential role in the development of pelvic floor disorders in women.Thus, androgen-related disorders may interfere with the function of pelvic floor muscles. [Many people mistakenly believe that androgens are only important for male sexual health:](https://www.bumc.bu.edu/sexualmedicine/patientinformation-physicians/androgen-insuffiency-in-women/#:~:text=Androgen%20insufficiency%20syndrome%2C%20characterized%20by,of%20sexual%20dysfunction%20in%20women.] Androgens have a three-fold action on female sexual function. They (1) increase libido by providing the fuel for a woman’s psychosexual stimulation, (2) increase sensitivity and blood flow to the external genitalia, and (3) increase the intensity of sexual gratification.
What I see in all these conditions is that sex hormone receptors become desensitized in the pelvic floor and genital tissues either from a drug, pelvic tightness, or inflammation from injury leading to less hormones being produced causing sexual and pelvic floor dysfunction. The pelvic floor now goes into a chronic tightened state as a response, leading to less oxygen and testosterone rich blood flow to the genital and pelvic region which leads to more androgen insensitivity and subsequently less DHT. This all explains why many people who have these conditions are helped by supplements that improve androgen receptor sensitivity and blood flow, and why pelvic floor therapy and exercises are so helpful to many of them. Estrogen receptor insensitivity in the pelvic floor also appears to have a similar mechanical negative effect by leading to less estrogen levels in the pelvic floor and genital tissues. It is also possible that some people with PSSD/PFS may have subtle or no pelvic floor symptoms, but the medication still desensitizes sex hormone sensitivity in their genitals and pelvic floor tissues that is leading to sexual dysfunction.
Another study linking androgens and the pelvic floor: Levator ani and other muscles of the pelvic floor and lower urinary tract are sensitive to the anabolic effects of testosterone. Androgen receptors are also expressed in the pelvic floor and lower urinary tract of both animals and humans. Anabolic effects of androgens may play an important role in the female pelvic-floor and lower-urinary-tract disorders. Furthermore, the interactions between androgen and nitric oxide synthase and arginase have been demonstrated, suggesting that androgens may also participate in modulating the physiological functions of the lower urinary tract through nitric oxide. The action of androgens in the lower urinary tract and pelvic floor is complex and may depend on their anabolic effects, hormonal modulation, receptor expression, interaction with nitric oxide synthase, or a combination of these effects.
My solution to help heal and improve the well-being of people with these issues is to try to improve sex hormone receptor sensitivity and pelvic floor function through supplements, stretches, exercises, and boosting blood flow which will hopefully restore normal levels of estrogens and androgens in pelvic, genital, and brain tissues. The body has a tremendous capability of self-healing, but we need to support it through active recovery methods.
We will first start with supplements (this is not professional medical advice - talk with your doctor before taking):
L-citrulline - This is the precursor to l-arginine, and it will improve blood flow and levels of nitric oxide to help get oxygen and testosterone rich blood to the pelvic floor and genital tissues to increase androgen sensitivity. Nitric oxide can also induce smooth muscle relaxation which is important for relaxing the pelvic floor. Herein we report on a young man affected by PSSD who regained sexual functioning after 3-month treatment with EDOVIS, a dietary supplement containing L-citrulline and other commonly used aphrodisiacs.. I recommend taking at least 6000 mg daily by taking 2000mg three times throughout the day. The max dose is 10,000mg. Even potentially better, people report great results using Cialis to improve blood flow and healing rather than L-citrulline and some doctors will even prescribe it to women if you show them the evidence - talk with your doctor. “Tadalafil (Cialis) reversal of sexual dysfunction caused by serotonin enhancing medications in women”. L-Citrulline and Cialis are not recommended to be taken together.
L-Carnitine - This will improve the number of androgen receptors and their sensitivity to testosterone to increase levels of DHT in the pelvic floor, genital tissues, and brain. I recommend taking 2000mg daily. Acetyl-L-Carnitine can pass through the blood-brain barrier, while Propionyl-L-carnitine has a high degree of interaction with testosterone. Propionyl may be better for sexual and pelvic floor dysfunction, while Acetyl might help people suffering from the mental effects of PSSD. This study used each at 2000mg daily to improve erectile dysfunction along with Viagra.. I would work up to 2000mg each of Acetyl and Propionyl L-Carnitine along with Cialis instead of Viagra as it lasts in the body for much longer (36 hours) for increased blood flow healing purposes. You can also use L-Citrulline instead of Cialis as mentioned earlier. Discuss with your doctor before taking them.
Vitamin D - This vitamin, which acts more like a hormone, works directly with the endocrine system. It has its own receptors throughout the body and they are often in close proximity to androgen receptors. Deficiency in vitamin D is associated with a stunting of testosterone's effects on androgen receptors and a decline in testosterone levels. Vitamin D will encourage androgen receptor resensitization. One study found that higher vitamin D levels are associated with a decreased risk of pelvic floor disorders in women, and The levator ani and coccygeus muscles are skeletal muscles that are critical components of the pelvic floor and may be affected by vitamin D nutritional status. I recommend 4000IU of vitamin D daily or whatever gets your levels to 60 - 80 ng/ml.
If you have inflammatory issues or pain due to pelvic floor dysfunction, I recommend a fish oil supplement daily. I take fish oil, and I find that it helps limit pelvic inflammation. I also take Magnesium Glycinate to relax the smooth muscle that lines the pelvic floor and genital tissue. I recommend it for people with clear pelvic floor dysfunction, but others should be careful as research says magnesium is a 5-alpha-reductase inhibitor. Take quercetin and bromelain as needed if you experience pelvic inflammatory flare ups and pain, but just be careful as quercetin can also inhibit the production of DHT from testosterone as well. Some say fish oil blocks DHT too, but experiencing chronic pelvic floor pain and inflammation will do more harm to you than minimal DHT blocking. I recommend staying away from all DHT inhibiting foods and supplements for people with PSSD, PFS, and PAS unless you are experiencing pelvic pain and inflammation.
As always, discuss these supplements with your doctor to see if they are okay for you. Lower your supplement intake based on side effects. These aren’t a magic cure, but a tool to help you on your journey to recovery. Don’t do anything without doctor supervision, but this thread gives more evidence for the “cure” for PSSD/PFS being resensitizing androgen receptors and estrogen receptors along with enhancing blood flow as it details how some men recovered through taking high doses of androgens, post cycle therapy, and Cialis. This at least gives hope that a hormonal cure can be created one day by medical professionals. I would of course recommend trying to heal yourself naturally for a long time before doing any hormone treatments under the supervision of a doctor.
I also recommend doing some form of yoga or pelvic floor stretches daily to improve blood flow for pelvic floor relaxation and sex hormone receptor sensitivity. You also need to request to see a pelvic floor therapist for an evaluation and treatment. Learn how to do reverse kegels. Doing reverse kegels will be difficult at first because your pelvic floor is tight and you have little to no awareness of these muscles, so just focus on lengthening and relaxing the pelvic floor through stretches for now. Do not do regular kegels for pelvic floor issues. Learn how to diaphragmatically breathe in 360 degrees to create expansion in your rib cage and abdomen to encourage pelvic floor relaxation. Do not breathe through your chest, and “belly breathing” isn’t the right term because the ribs need to expand as well. You can learn how to diaphragmatically breathe through an exercise such as 4-7-8 breathing. Here is a great video on diaphragmatic breathing and another video. I cannot overstate it enough: retraining yourself to properly breathe diaphragmatically is the single most important thing that you can do to heal from pelvic floor issues. Be a student of breathing: study and take notes on how to breathe better.
Stretches/Yoga poses I recommend:
Hold the Malasana/hindi/yoga squat pose for at least 5-10 minutes at least twice a day, but doing it morning, mid-day, and at night would be the best. Some get great results holding it for 15-20 minutes.This is one of the most important things for your pelvic floor because it will help lengthen and release it. Doing them barefoot is also very beneficial to strengthen your ankles and feet which are connected to your pelvic floor. Again, remember to breathe deeply down into your belly and pelvic floor for all these stretches.
Begin your stretching routine with an Exercise ball ab stretch and Upward-facing dog/cobra pose. This will help stretch your lower abs and psoas muscles so that you can get more breath deeper down into your pelvic floor for the rest of your stretches. Some people say that these types of stretches aren’t great for people who have Anterior Pelvic Tilt, which we should fix, but I still do them as it is important to stretch the lower abs that are hard to get to. You can experiment with doing them sporadically instead of every time you stretch.
This is my current personal complete stretch routine I do in order 3+ days a week:
Myofascial release on my glutes with an orb massage ball but you can use any small hard ball (don’t do this if glutes are currently sore) > Calf stretch against a wall or a yoga block which is what I use > exercise ball ab stretch > upward facing dog > (optional) Do a handful of cat cows > Supine hamstring stretch with yoga strap or an IdealStretch tool which is what I use > Kneeling hip flexor stretch > flat on back supine single knee to chest stretch > then bring knee to opposite shoulder stretch > supine figure four > I do this stretch next right after figure four > Reclined bound angle pose > (optional) butterfly stretch > (optional) A little bit of downward facing dog to stretch the calves > (optional) Lizard Pose) > (optional) Half split stretch/Half monkey pose with yoga blocks > Half-pigeon pose > Child’s pose > Wall quad hip flexor stretch > Wall figure four stretch > Wall straddle pose > Wall happy baby pose > Flat on back while pulling knees apart > kneeling with one leg, other leg out to side for adductors > (optional) Frog pose with feet together > regular Frog pose with feet separated in line with the knees > Yoga squat/malasana > Corpse pose
All these stretches are the ones I found most useful in a routine. See what works for you and develop your own routine. Consistency is the most important. This long stretching routine may not be possible for you to complete regularly so make adjustments, but doing this routine at least 3 days a week is ideal. Stretches such as the yoga squat, supine hamstring stretch, hip flexor stretches, and wall stretches are vital and should be done most days to help relax the pelvic floor. For how long you should hold each stretch, just go by how you and your body feels. Really let go, breathe, and sink into every stretch. On rest days, doing some deep breathing in child’s pose, reclined bound angle pose, flat on back while pulling knees apart, and the happy baby wall pose is really great while trying to do gentle reverse kegels.
You can also work on more individualized stretches for posture to correct anterior pelvic tilt, muscle imbalances, and to release other tight muscles, such as the upper body. Listen to your body if you need to give yourself a rest day from stretching. Adding in a 30-60 minute walk/swim on rest days is incredibly beneficial as well. Eventually, you can also try to learn isometric PNF stretching to incorporate it into some of the stretches such as the kneeling hip flexor stretch and hamstring stretch.
After working to relax and lengthen your pelvic floor through yoga and stretches, I would begin gentle body strengthening exercises that are pelvic floor safe. The pelvic floor is a master compensator. So, if the glutes, adductors, deep hip rotators, transversus abdominis, and other supportive muscles are weak, then the pelvic floor is in the prime position to pick up the slack which leads to a lot of strain on the pelvic floor which results in tightness and dysfunction. You need to strengthen the surrounding muscles to relieve tightness in the pelvic floor. This is where working with a pelvic floor therapist would be helpful to point out safe individualized exercises for you. Yoga will help strengthen your muscles in a safe way too.
The glutes and transversus abdominis in particular are very important to strengthen. Glute bridge, single glute bridge, side lying leg raises, lateral band walks can help build up glute strength. Deadbugs, Bird Dog, 8- point planks, or planks with pelvic floor-friendly modifications, can help to strengthen the transversus abdominis (TVA). Abdominal work may be triggering to your pelvic floor symptoms, especially the 8 point plank, so you can instead look into hypopressive exercises to work the TVA without overworking the pelvic floor. These exercises will help you bring more awareness to your breathing, diaphragm, TVA, and pelvic floor which are all important for recovery. Here is how to find and become aware of the TVA. Do side planks for your oblique ab muscles.
For hip/abductors do the side lying hip abduction exercise, fire hydrants, and the shinbox lunge. For the adductors, do Copenhagen adductor exercise, cossack squats, and an exercise where you squeeze a soft ball between the knees just don’t do any crunch movements with pelvic floor issues. For hamstrings, Nordic hamstring curl/glute ham raises, and single leg bridge. For the back, do supine pelvic tilt. One person even reported that dorsiflexion exercises and stretches were one important element to solve his pelvic floor issues; this is most likely because the ankle bone, like everything else including even our jaw, is connected to the pelvic floor.
Like with anything, do all these exercises in moderation and stop if you sense your pelvic floor is not responding well to them - do them one at a time to see which ones your pelvic floor can handle for now. Here is an exercise routine from another poster that has helped many people. Just be careful of the ab exercises such as the ab wheel and 5 minute planks with your pelvic floor issues - don’t over do it or avoid it if they cause too many symptoms.
Myofascial release and foam rolling to release trigger points also helps a lot of people to relax their pelvic floor muscles and improve blood flow. The glutes are the most important area to target for pelvic floor issues when foam rolling in my experience if you only had limited time. Using a soft ball to lay on and breathe deeply can help release trigger points in the abdominal muscles and psoas which can help you breathe better and relax the pelvic floor. I haven’t done it, but you can also try out a massage gun for myofascial release; just be careful and don’t use it in sensitive pelvic areas. Some men and women also report success using a therawand to release internal trigger points that are causing them pelvic floor dysfunction symptoms.
Walking and swimming for 30-60 minutes are some of the best exercises to lengthen, relax, stretch, and release your pelvic floor, boost blood flow, and help to retain and build strength in muscles that give support to the pelvic floor. Walk or swim for 5+ days a week for the best results. The breaststroke and freestyle are very helpful for pelvic floor sufferers. Along with swimming, people also use an elliptical at a low resistance to help provide a cardio workout that is safer for your pelvic floor.
Fix your posture. Pelvic floor issues and hard flaccid syndrome are closely associated with Anterior Pelvic Tilt and other postural issues. Get evaluated by a physical therapist so that they can give you exercises and stretches to fix it. You could also look into the Postural Restoration institute and see one of their providers and try to implement some of their exercises. In the meantime, here is one video playlist on how to fix APT. Another video to fix APT says to stretch the hip flexors, lower back, while focusing on strengthening the abs, glutes, and hamstrings. Make sure that you sit and walk with good posture - watch this to learn how to walk correctly - activate your glutes during each step and push off with your back foot!. I also recommend getting a standing desk to try to avoid sitting for long periods of time.
Weight training can be effective for boosting active androgen receptors in the body to increase testosterone and DHT levels. However, you need to make sure that it isn’t making your pelvic floor symptoms worse which defeats the purpose. If you are going to lift weights with pelvic floor issues, don’t lift heavy, do any intensive ab workouts, or any other exercises that can put extra strain on your pelvic floor. Do lifts where you can sit down instead of standing up. Start with yoga, stretching, and gentle body exercises to relax your pelvic floor and strengthen surrounding muscles before incorporating consistent weight training. I highly recommend, however, just sticking with yoga and pelvic floor safe body weight exercises to build strength instead. Those with PSSD without pelvic floor dysfunction may benefit a lot from lifting weights, high-intensity interval training, and doing bodyweight exercises such as squats regularly to boost androgen receptors and DHT. Remember to see a pelvic floor therapist to get evaluated first before starting any weight lifting because many people have pelvic floor issues without even realizing it.
Work on your mental health. Anxiety can worsen pelvic floor issues. Just as dogs tuck and tense their tails when stressed, we tense our pelvic floors which are directly connected to our tailbone where we used to have tails ourselves in our evolutionary history. As we are impacted by sexual dysfunction and pelvic floor dysfunction symptoms, we become anxious along with other negative emotions which leads to more pelvic floor tension symptoms due to the fight or flight mode response causing even more anxiety leading to more symptoms. It is a vicious cycle that needs to break by not becoming anxious and negative when we experience pelvic floor symptoms or hard flaccid and instead let go, accept, and realize that it is a normal process when trying to heal because sometimes our muscles that are used to that tightness don't want to let go of the tension we hold in our pelvic floors. Daily yoga, meditation, stretching, and walking will help with anxiety. I would also see a mental health therapist because all of these issues are deeply traumatic and we cannot go through this alone. We often hold tension in the form of emotions and trauma in our bodies, especially our pelvic floor and genital areas. By openly talking about these issues with a therapist, it will help us process and release our emotions and trauma that we are holding inside our bodies to improve our anxiety, relax our pelvic floor, and to let go of all of our tension. Many people who healed their hard flaccid and pelvic floor issues said that solving their anxiety and negative thoughts by talking to a mental health counselor was vital in recovery. The mind-body connection is so powerful, and it directly impacts our pelvic floor. Those who are stuck in the cycle of experiencing pelvic floor symptoms leading to anxiety and negative thoughts will also benefit from Cognitive Behavioral Therapy you can do by yourself like in this video or preferably with a trained therapist. Here is an informative mini lecture on how stress impacts the pelvic floor.
I would also definitely go on a healthy anti-inflammatory diet. Avoid caffeine, alcohol, marijuana, and other substances. Avoid foods and liquids that can trigger pelvic floor inflammation such as highly acidic fruits and veggies, carbonated beverages, very spicy foods, and artificial sugars. To maintain a healthy gut to reduce inflammation in your body I recommend trying a low-histamine probiotic supplement along with eating healthy. You should also work on preventing or fixing constipation; eat a lot of soluble fiber to not get constipated - take a supplement such as metamucil if you have to. Check the Bristol stool shape chart to identify if you are constipated because even mild constipation can contribute to pelvic floor tension. This is because the constipation leads to a lot of pressure being put on your rectum and pelvic floor leading to the muscles becoming weak and dysfunctional. I am willing to bet many of you are constipated and don’t know it because it isn’t just whether you go regularly, it is also how your stool is shaped. People with pelvic floor disorders are at a high risk of constipation which makes their tension and dysfunction worse which then worsens the constipation, another cycle to fix. I recommend getting a Squatty Potty to reduce strain on the pelvic floor during elimination.
To help heal hard flaccid and pelvic floor issues, never watch pornography again (this is vital). Go on NoFap for 90+ days to help heal your brain and body from any unhealthy pornography and sexual habits you have partaken in. Pornography leads to involuntary kegels, a tight pelvic floor, desensitizes you, and messes up the dopamine and arousal circuitry in your brain. Don’t climax too often. Learn how to reverse kegel by yourself and during sexual activities. Never edge or regular kegel - it leads to pelvic floor tightness and dysfunction - just relax your arousal through a reverse kegel. Keep your pelvic floor relaxed during sexual activities.
Stay strong and never give up. You will heal. Thank you for reading.

Marlins (10-27) @ Dodgers (24-13)

First Pitch: 7:10 PM at Dodger Stadium

Team	Starter	TV	Radio
Marlins	Edward Cabrera (1-1, 6.05 ERA)	BSFL	FOX940AM, WAQI (ES)
Dodgers	Yoshinobu Yamamoto (3-1, 2.91 ERA)	SNLA	570, KTNQ (ES)

MLB	Fangraphs	Reddit Stream	Discord
Gameday	Game Graph	Live Comments	/baseball Discord

Line Score - Runner on first, 1 Out, Bottom of the 1st

	1	2	3	4	5	6	7	8	9	R	H	E	LOB
MIA	1									1	2	0	1
LAD										0	0	0	-

Box Score

LAD		AB	R	H	RBI	BB	SO	BA
SS	Betts	1	0	0	0	0	0	.354
DH	Ohtani	0	0	0	0	1	0	.370
1B	Freeman, F	0	0	0	0	0	0	.292
C	Smith, W.D.	0	0	0	0	0	0	.336
3B	Muncy	0	0	0	0	0	0	.255
LF	Hernández, T	0	0	0	0	0	0	.259
RF	Pages	0	0	0	0	0	0	.319
2B	Lux	0	0	0	0	0	0	.186
CF	Outman	0	0	0	0	0	0	.169

LAD	IP	H	R	ER	BB	SO	P-S	ERA
Yamamoto	1.0	2	1	1	0	1	12-12	3.09

MIA		AB	R	H	RBI	BB	SO	BA
CF	Chisholm Jr.	1	1	1	1	0	0	.248
DH	De La Cruz, B	1	0	0	0	0	0	.262
3B	Burger	1	0	0	0	0	1	.210
1B	Bell	1	0	1	0	0	0	.204
RF	Sánchez, J	1	0	0	0	0	0	.231
SS	Anderson, Ti	0	0	0	0	0	0	.211
LF	Gordon	0	0	0	0	0	0	.212
2B	Bruján	0	0	0	0	0	0	.276
C	Bethancourt	0	0	0	0	0	0	.070

MIA	IP	H	R	ER	BB	SO	P-S	ERA
Cabrera, E	0.1	0	0	0	1	0	13-6	5.95

Scoring Plays

Inning	Event	Score
T1	Jazz Chisholm Jr. homers (5) on a fly ball to right center field.	0-1

Highlights

Description	Length
Edward Cabrera against the Dodgers	0:07
Bullpen availability for Los Angeles, May 7 vs Marlins	0:07
Bullpen availability for Miami, May 7 vs Dodgers	0:07
Bench availability for Los Angeles, May 7 vs Marlins	0:07
Fielding alignment for Los Angeles, May 7 vs Marlins	0:11
Bench availability for Miami, May 7 vs Dodgers	0:07
Fielding alignment for Miami, May 7 vs Dodgers	0:11
Starting lineups for Marlins at Dodgers - May 7, 2024	0:09
Measuring the stats on Jazz Chisholm Jr.'s home run	0:13
Jazz Chisholm Jr.'s leadoff homer (5)	0:31

Attendance	Weather	Wind
	66°F, Clear	7 mph, Out To RF

HP	1B	2B	3B
Roberto Ortiz	Alfonso Márquez	Lance Barrett	Mark Ripperger

Updated at 7:22 PM.
Remember to sort by new to keep up!

Join us on Discord!

Marlins (10-27) @ Dodgers (24-13)

First Pitch: 10:10 PM at Dodger Stadium

Team	Starter	TV	Radio
Marlins	Edward Cabrera (1-1, 6.05 ERA)	BSFL	FOX940AM, WAQI (ES)
Dodgers	Yoshinobu Yamamoto (3-1, 2.91 ERA)	SNLA	570, KTNQ (ES)

MLB	Fangraphs	Reddit Stream	IRC Chat
Gameday	Game Graph	Live Comments	Libera: ##baseball

Line Score - Runner on first, 1 Out, Bottom of the 1st

	1	2	3	4	5	6	7	8	9	R	H	E	LOB
MIA	1									1	2	0	1
LAD										0	0	0	-

Box Score

LAD		AB	R	H	RBI	BB	SO	BA
SS	Betts	1	0	0	0	0	0	.354
DH	Ohtani	0	0	0	0	1	0	.370
1B	Freeman, F	0	0	0	0	0	0	.292
C	Smith, W.D.	0	0	0	0	0	0	.336
3B	Muncy	0	0	0	0	0	0	.255
LF	Hernández, T	0	0	0	0	0	0	.259
RF	Pages	0	0	0	0	0	0	.319
2B	Lux	0	0	0	0	0	0	.186
CF	Outman	0	0	0	0	0	0	.169

LAD	IP	H	R	ER	BB	SO	P-S	ERA
Yamamoto	1.0	2	1	1	0	1	12-12	3.09

MIA		AB	R	H	RBI	BB	SO	BA
CF	Chisholm Jr.	1	1	1	1	0	0	.248
DH	De La Cruz, B	1	0	0	0	0	0	.262
3B	Burger	1	0	0	0	0	1	.210
1B	Bell	1	0	1	0	0	0	.204
RF	Sánchez, J	1	0	0	0	0	0	.231
SS	Anderson, Ti	0	0	0	0	0	0	.211
LF	Gordon	0	0	0	0	0	0	.212
2B	Bruján	0	0	0	0	0	0	.276
C	Bethancourt	0	0	0	0	0	0	.070

MIA	IP	H	R	ER	BB	SO	P-S	ERA
Cabrera, E	0.1	0	0	0	1	0	13-6	5.95

Scoring Plays

Inning	Event	Score
T1	Jazz Chisholm Jr. homers (5) on a fly ball to right center field.	0-1

Highlights

Description	Length
Edward Cabrera against the Dodgers	0:07
Bullpen availability for Los Angeles, May 7 vs Marlins	0:07
Bullpen availability for Miami, May 7 vs Dodgers	0:07
Bench availability for Los Angeles, May 7 vs Marlins	0:07
Fielding alignment for Los Angeles, May 7 vs Marlins	0:11
Bench availability for Miami, May 7 vs Dodgers	0:07
Fielding alignment for Miami, May 7 vs Dodgers	0:11
Starting lineups for Marlins at Dodgers - May 7, 2024	0:09
Measuring the stats on Jazz Chisholm Jr.'s home run	0:13
Jazz Chisholm Jr.'s leadoff homer (5)	0:31

Attendance	Weather	Wind
	66°F, Clear	7 mph, Out To RF

HP	1B	2B	3B
Roberto Ortiz	Alfonso Márquez	Lance Barrett	Mark Ripperger

Updated at 10:20 PM.
Remember to sort by new to keep up!

I got my results for a metabolic panel today and I am concerned because according to this my liver enzymes are off the charts. These three results were flagged:
AST: 192 U/L, reference range 10-40 ALT: 99 U/L, reference range 9-46 Globulin: 1.9 g/dL, reference range 1.9-3.7 Glucose: 52 mg/L, reference range 65-99
About me: 29 yo male, 120 lbs, just started exercising regularly last week after being pretty sedentary for a long time. Currently taking:
Nattokinase-serrapaptese (blood thinning supplement) Magnesium B Complex L-Tyrosine Bacillus Subtilis probiotic
I did not take Tylenol or drink alcohol the day before my test, or fast (said no fasting). My last workout was 48 hours before the blood draw.

D-backs @ Reds - Tue, May 07

Game Status: Final - Score: 6-2 D-backs

Links & Info

• MLB Gameday
• Game Graphs
• Savant Gamefeed

	D-backs Batters	AB	R	H	RBI	BB	K	LOB	AVG	OBP	SLG
1	Carroll - CF	5	1	2	5	0	1	2	.211	.300	.278
2	Marte, K - 2B	5	1	1	1	0	2	4	.303	.356	.535
3	Gurriel Jr. - LF	4	0	0	0	0	2	2	.234	.276	.387
4	Walker, C - 1B	4	0	0	0	0	1	0	.271	.381	.465
5	Pederson - DH	4	0	1	0	0	3	0	.295	.412	.513
6	Suárez, E - 3B	4	0	0	0	0	2	1	.215	.283	.315
7	McCarthy - RF	1	1	0	0	1	0	0	.307	.369	.387
	a-Grichuk - RF	2	0	1	0	0	0	0	.271	.315	.417
8	Barnhart - C	3	2	1	0	1	0	1	.229	.325	.286
9	Newman - SS	4	1	2	0	0	1	3	.200	.226	.333
	Totals	36	6	8	6	2	12	13

D-backs
a-Singled for McCarthy in the 7th.
BATTING: 2B: Pederson (8, Montas). HR: Carroll (2, 7th inning off Wilson, 2 on, 1 out); Marte, K (7, 7th inning off Wilson, 0 on, 1 out). TB: Barnhart; Carroll 5; Grichuk; Marte, K 4; Newman 2; Pederson 2. RBI: Carroll 5 (12); Marte, K (18). Runners left in scoring position, 2 out: Suárez, E; Gurriel Jr. 2. Team RISP: 2-for-7. Team LOB: 5.
FIELDING: DP: (Newman-Marte, K-Walker, C).

	Reds Batters	AB	R	H	RBI	BB	K	LOB	AVG	OBP	SLG
1	Friedl - CF	4	0	0	0	0	1	1	.000	.000	.000
2	De La Cruz, E - SS	4	0	0	0	0	1	1	.262	.366	.533
3	Steer - LF	3	0	0	0	1	0	1	.240	.347	.416
4	Stephenson, T - C	4	1	1	1	0	1	1	.213	.318	.413
5	Fraley - DH	3	0	1	0	1	0	0	.294	.360	.397
6	Encarnacion-Strand - 1B	3	0	0	0	1	1	2	.190	.220	.293
7	India - 2B	3	1	1	1	0	1	2	.222	.341	.324
8	Candelario - 3B	3	0	0	0	0	1	1	.184	.267	.350
9	Benson - RF	2	0	0	0	1	2	0	.191	.273	.391
	Totals	29	2	3	2	4	8	9

Reds
BATTING: HR: India (2, 7th inning off Jarvis, 0 on, 2 out); Stephenson, T (4, 9th inning off Sewald, 0 on, 1 out). TB: Fraley; India 4; Stephenson, T 4. RBI: India (11); Stephenson, T (11). 2-out RBI: India. Runners left in scoring position, 2 out: Steer; Candelario. GIDP: Encarnacion-Strand. Team RISP: 0-for-2. Team LOB: 4.
FIELDING: E: De La Cruz, E (7, fielding).

D-backs Pitchers	IP	H	R	ER	BB	K	HR	P-S	ERA
Gallen (W, 4-2)	6.0	1	0	0	3	6	0	79-47	2.84
Jarvis	1.0	1	1	1	1	0	1	16-8	5.14
Mantiply	1.0	0	0	0	0	1	0	15-9	3.68
Sewald	1.0	1	1	1	0	1	1	15-11	9.00
Totals	9.0	3	2	2	4	8	2

Reds Pitchers	IP	H	R	ER	BB	K	HR	P-S	ERA
Montas (L, 2-3)	6.0	4	2	1	1	7	0	87-61	3.55
Wilson	0.1	4	4	4	0	0	2	21-13	8.59
Farmer, B	1.2	0	0	0	0	2	0	22-17	2.79
Pagán	1.0	0	0	0	1	3	0	16-11	5.52
Totals	9.0	8	6	5	2	12	2

Game Info
WP: Gallen.
Pitch timer violations: Montas (pitcher).
Pitches-strikes: Gallen 79-47; Jarvis 16-8; Mantiply 15-9; Sewald 15-11; Montas 87-61; Wilson 21-13; Farmer, B 22-17; Pagán 16-11.
Groundouts-flyouts: Gallen 5-5; Jarvis 2-0; Mantiply 1-0; Sewald 1-0; Montas 5-4; Wilson 1-0; Farmer, B 0-1; Pagán 0-0.
Batters faced: Gallen 22; Jarvis 4; Mantiply 3; Sewald 4; Montas 24; Wilson 5; Farmer, B 5; Pagán 4.
Umpires: HP: Vic Carapazza. 1B: Adam Hamari. 2B: Edwin Moscoso. 3B: D.J. Reyburn.
Weather: 75 degrees, Cloudy.
Wind: 11 mph, R To L.
First pitch: 6:40 PM.
T: 2:27.
Att: 14,485.
Venue: Great American Ball Park.
May 7, 2024

Inning	Scoring Play	Score
Top 3	Corbin Carroll grounds into a force out, pitcher Frankie Montas to shortstop Elly De La Cruz. Jake McCarthy scores. Tucker Barnhart out at 2nd. Corbin Carroll to 1st.	1-0 AZ
Top 5	Corbin Carroll singles on a ground ball to center fielder TJ Friedl. Tucker Barnhart scores. Kevin Newman to 3rd.	2-0 AZ
Top 7	Corbin Carroll homers (2) on a fly ball to left center field. Tucker Barnhart scores. Kevin Newman scores.	5-0 AZ
Top 7	Ketel Marte homers (7) on a line drive to center field.	6-0 AZ
Bottom 7	Jonathan India homers (2) on a fly ball to center field.	6-1 AZ
Bottom 9	Tyler Stephenson homers (4) on a fly ball to center field.	6-2 AZ

Team	Highlight
CIN	Tyler Stephenson: Home Run Statcast Analysis (00:00:12)
AZ	Corbin Carroll's RBI single (00:00:16)
CIN	Reds catch Kevin Newman in a rundown (00:00:29)
AZ	Corbin Carroll's three-run homer (2) (00:00:29)
AZ	Ketel Marte's solo home run (7) (00:00:28)
CIN	Jonathan India's solo homer (2) (00:00:28)
AZ	Corbin Carroll and Ketel Marte go back-to-back (00:00:58)
CIN	Bengals' Geno Stone throws first pitch (00:00:21)
AZ	Zac Gallen whiffs six (00:01:14)
CIN	Tyler Stephenson's solo home run (4) (00:00:25)

	1	2	3	4	5	6	7	8	9		R	H	E	LOB
D-backs	0	0	1	0	1	0	4	0	0		6	8	0	5
Reds	0	0	0	0	0	0	1	0	1		2	3	1	4

Decisions

• Winner: Zac Gallen (4-2, 2.84)
• Loser: Frankie Montas (2-3, 3.55)

Division Scoreboard

LAA 9 @ PIT 0 - Final
SD 2 @ CHC 2 - Middle 9
MIL 6 @ KC 5 - Bottom 9, 0 Outs
NYM 6 @ STL 4 - Bottom 8, 0 Outs
Next Reds Game: Wed, May 08, 06:40 PM EDT vs. D-backs
^{Last Updated: 05/07/2024 10:09:34 PM EDT}

Hi everyone - could use some help interpreting OGTT results. This post is a follow-on to my previous post.
Some quick background:

• 5'11", 25M, 162 pounds.
• About 70th percentile for muscle mass (ALMI) and age.
• 5-10 hours of cardio exercise per week. My FTP on the bike is probably ~3.6 w/kg.
• HBA1C across the board (varying from 5.4% - 6.1% in as little as a 15-day period; I'm convinced A1C is a bad measurement in individuals - primarily due to varying individual RBC turnover rates).
• CGM 90-day average glucose of 100 mg/dL (corresponds to an estimated A1C of ~5.1%, I believe).
• LP-IR (lipoprotein insulin resistance) score of 55 (~65th percentile for all ages) - yikes.
• Daily carb consumption is about 80-130 grams for the last several months. Mostly coming from nuts, beans, and glucose shakes (while on the bike; I now reserve this strictly for longer rides).
• VAT (visceral adipose tissue) mass at ~281 grams (looks to be about 50th percentile for my age, more concerning when we account for my fat mass percentile being much lower - 25th percentile maybe).
• HDL and trigs out of wack at 44 & 160, respectively.
• ALT/AST at about 22.
• Low-moderate stress. Good sleep.

OGTT results as follows:

• 0 mins - 76 glucose; 2.9 insulin (Attia guides to <90 and <6).
• 30 mins - 160 glucose; 63.9 insulin (Attia guides to <140 and <40).
• 60 mins - 125 glucose; 87.5 insulin (Attia guides to <120 and <30).
• 90 mins - 59 glucose; 14.3 insulin (Attia guides to <100 and <20).
• 120 mins - 32 glucose; 4.3 insulin (no Attia guidance, I believe).

Clearly very hypoglycemic at 90 & 120 minutes. Looks like insulin response is also delayed and elevated. Additionally, LP-IR of 55 (~65th percentile) indicates some level of insulin resistance. Also, I did carb-load for 3 days prior to the OGTT.
Right now, my plan is to do the following:

• Continue cardio at 5-7 hours/week.
• Lose some weight as a means of shedding visceral fat. Plan is to drop from Dexa 17.3% body fat to about ~12%.
• Lift 2-3 times per week to maintain lean mass during weight loss, as well as increase glycogen sink.
• Continue low-carb diet, potentially dipping into keto territory, and pretty much eliminating weekend alcohol and cheat meals.
• Potentially resume statin & ezetimibe (LDL-C at 150); I'd previously ceased given concerns with A1C and liver enzymes, but believe these concerns may have been (1) misrepresented in a1c (given significant variance in the metric, perhaps not causally linked to statin; will use CGM as a better indicator going forward) and (2) unwarranted in the case of elevated transaminases - I hear that ALT/AST are often transiently elevated at the beginning of statin therapy, and are often self-resolving (not certain on timing).

I'm wondering if anyone could provide some insight into my OGTT results (particularly the reactive hypoglycemia), my level of insulin resistance, and potential guidance for next steps.
Apologies for the wordiness - and thanks so much in advance!

Fanapt (unsure of mg bc I have a blister sample pack), Ativan 0.5 mg (! She actually prescribed it), and Depakote ER 500 mg.
Does Depakote make you tired? I struggle with insomnia. I'd like to feel sleepy for once. Took the pills earlier.

Tigers @ Guardians - Tue, May 07

Game Status: Final - Score: 11-7 Tigers

Links & Info

• MLB Gameday
• Game Graphs
• Savant Gamefeed

	Tigers Batters	AB	R	H	RBI	BB	K	LOB	AVG	OBP	SLG
1	Ibáñez - 2B	4	4	4	4	1	0	0	.364	.361	.576
2	Pérez, W - CF	5	1	2	0	0	2	1	.305	.388	.542
3	Vierling - 3B	5	0	2	2	0	0	2	.282	.306	.437
4	Greene, R - LF	5	1	1	0	0	1	3	.264	.385	.535
5	Rogers - DH	5	2	2	0	0	1	2	.194	.256	.319
6	Torkelson - 1B	4	1	1	0	1	1	1	.218	.286	.308
7	Vilade - RF	4	0	2	3	1	0	2	.500	.600	.500
8	Báez, J - SS	5	1	1	1	0	2	3	.181	.221	.248
9	Kelly, C - C	3	1	0	0	1	1	1	.175	.254	.246
	Totals	40	11	15	10	4	8	15

Tigers
BATTING: 2B: Rogers 2 (3, Allen, L.T., Smith, C); Torkelson (12, Allen, L.T.); Ibáñez (1, Herrin). HR: Ibáñez 2 (2, 1st inning off Allen, L.T., 0 on, 0 out, 2nd inning off Allen, L.T., 2 on, 2 out). TB: Báez, J; Greene, R; Ibáñez 11; Pérez, W 2; Rogers 4; Torkelson 2; Vierling 2; Vilade 2. RBI: Báez, J (11); Ibáñez 4 (7); Vierling 2 (13); Vilade 3 (3). 2-out RBI: Ibáñez 3; Báez, J. Runners left in scoring position, 2 out: Greene, R; Kelly, C. GIDP: Báez, J; Vierling; Vilade. Team RISP: 5-for-11. Team LOB: 6.
FIELDING: DP: 2 (Vierling-Báez, J-Torkelson; Ibáñez-Báez, J-Torkelson).

	Guardians Batters	AB	R	H	RBI	BB	K	LOB	AVG	OBP	SLG
1	Florial - RF	5	1	1	1	0	1	2	.206	.280	.426
2	Gimenez - 2B	3	1	0	0	1	1	3	.263	.333	.353
3	Ramírez, Jo - 3B	4	1	3	2	0	0	1	.245	.290	.448
4	Naylor, J - 1B	3	2	1	2	1	0	2	.276	.364	.553
5	Brennan - RF	3	0	1	2	0	0	1	.247	.288	.423
	a-Fry - LF	1	0	0	0	0	0	1	.321	.449	.453
6	Freeman, T - CF	4	0	0	0	0	1	2	.196	.291	.333
7	Naylor, B - C	4	1	1	0	0	0	0	.176	.272	.286
8	Manzardo - DH	4	0	0	0	0	2	1	.000	.000	.000
9	Rocchio - SS	2	1	1	0	2	0	0	.212	.313	.293
	Totals	33	7	8	7	4	5	13

Guardians
a-Flied out for Brennan in the 8th.
BATTING: 2B: Brennan (5, Maeda); Florial (4, Maeda); Ramírez, Jo (6, Holton, T). HR: Naylor, J (9, 2nd inning off Maeda, 1 on, 2 out). TB: Brennan 2; Florial 2; Naylor, B; Naylor, J 4; Ramírez, Jo 4; Rocchio. RBI: Brennan 2 (14); Florial (10); Naylor, J 2 (28); Ramírez, Jo 2 (30). 2-out RBI: Naylor, J 2; Brennan 2; Ramírez, Jo 2. Runners left in scoring position, 2 out: Florial; Freeman, T. GIDP: Brennan; Gimenez. Team RISP: 3-for-7. Team LOB: 3.
FIELDING: E: Naylor, B 2 (3, throw, throw). DP: 3 (3 Rocchio-Gimenez-Naylor, J).

Tigers Pitchers	IP	H	R	ER	BB	K	HR	P-S	ERA
Maeda	2.0	5	7	7	3	1	1	59-33	6.75
Holton, T (W, 3-0)	3.0	2	0	0	0	3	0	31-22	4.00
Faedo (H, 3)	2.0	0	0	0	0	1	0	18-13	2.35
Chafin	1.0	1	0	0	0	0	0	11-7	1.35
Lange	1.0	0	0	0	1	0	0	20-10	0.68
Totals	9.0	8	7	7	4	5	1

Guardians Pitchers	IP	H	R	ER	BB	K	HR	P-S	ERA
Allen, L.T.	2.1	7	7	7	2	2	2	67-38	6.41
Avila (L, 1-1)	3.0	3	1	1	2	4	0	53-30	6.11
Smith, C	1.0	2	1	1	0	0	0	20-12	2.70
Herrin	1.2	3	2	1	0	2	0	18-16	1.06
Barlow, S	1.0	0	0	0	0	0	0	9-8	2.45
Totals	9.0	15	11	10	4	8	2

Game Info
WP: Lange; Allen, L.T.; Avila; Herrin.
Pitch timer violations: Maeda (pitcher).
Pitches-strikes: Maeda 59-33; Holton, T 31-22; Faedo 18-13; Chafin 11-7; Lange 20-10; Allen, L.T. 67-38; Avila 53-30; Smith, C 20-12; Herrin 18-16; Barlow, S 9-8.
Groundouts-flyouts: Maeda 0-2; Holton, T 3-1; Faedo 2-2; Chafin 0-2; Lange 1-1; Allen, L.T. 2-0; Avila 3-0; Smith, C 1-1; Herrin 3-0; Barlow, S 3-0.
Batters faced: Maeda 14; Holton, T 9; Faedo 6; Chafin 4; Lange 4; Allen, L.T. 15; Avila 13; Smith, C 5; Herrin 8; Barlow, S 3.
Inherited runners-scored: Avila 2-2; Smith, C 1-0; Herrin 1-1.
Umpires: HP: Adrian Johnson. 1B: Quinn Wolcott. 2B: Junior Valentine. 3B: Ramon De Jesus.
Weather: 72 degrees, Drizzle.
Wind: 3 mph, Calm.
First pitch: 6:10 PM.
T: 2:45.
Att: 15,531.
Venue: Progressive Field.
May 7, 2024

Inning	Scoring Play	Score
Top 1	Andy Ibáñez homers (1) on a fly ball to left field.	1-0 DET
Bottom 1	Will Brennan doubles (5) on a sharp line drive to center fielder Wenceel Pérez. Andrés Giménez scores. Josh Naylor scores.	2-1 CLE
Top 2	Javier Báez singles on a ground ball to center fielder Tyler Freeman. Jake Rogers scores.	2-2
Top 2	Andy Ibáñez homers (2) on a fly ball to right field. Javier Báez scores. Carson Kelly scores.	5-2 DET
Bottom 2	Estevan Florial doubles (4) on a line drive to right fielder Ryan Vilade. Bo Naylor scores. Brayan Rocchio to 3rd.	5-3 DET
Bottom 2	José Ramírez singles on a sharp line drive to center fielder Wenceel Pérez. Brayan Rocchio scores. Estevan Florial scores.	5-5
Bottom 2	Josh Naylor homers (9) on a fly ball to right field. José Ramírez scores.	7-5 CLE
Top 3	Ryan Vilade singles on a line drive to left fielder Estevan Florial. Riley Greene scores. Spencer Torkelson scores.	7-7
Top 4	Matt Vierling grounds into a double play, shortstop Brayan Rocchio to second baseman Andrés Giménez to first baseman Josh Naylor. Andy Ibáñez scores. Wenceel Pérez out at 2nd. Matt Vierling out at 1st.	8-7 DET
Top 7	Ryan Vilade singles on a ground ball to left fielder Estevan Florial. Jake Rogers scores.	9-7 DET
Top 8	Matt Vierling singles on a line drive to center fielder Tyler Freeman. Andy Ibáñez scores. Wenceel Pérez scores.	11-7 DET

Team	Highlight
DET	Andy Ibáñez's leadoff home run (1) (00:00:24)
DET	Andy Ibáñez's second home run (2) (00:00:29)
CLE	José Ramírez's two-run single (00:00:23)
CLE	Josh Naylor's two-run home run (9) (00:00:28)
DET	Tigers score run on a double play (00:00:20)
CLE	Guardians score five runs in electric 2nd inning (00:01:13)
DET	Ryan Vilade's RBI single (00:00:26)
DET	Matt Vierling's two-run single (00:00:28)
DET	Alex Lange finishes off Tigers' win vs. Guardians (00:00:18)
DET	Andy Ibáñez homers twice in four-hit game (00:01:38)

	1	2	3	4	5	6	7	8	9		R	H	E	LOB
Tigers	1	4	2	1	0	0	1	2	0		11	15	0	6
Guardians	2	5	0	0	0	0	0	0	0		7	8	2	3

Decisions

• Winner: Tyler Holton (3-0, 4.00)
• Loser: Pedro Avila (1-1, 6.11)

Division Scoreboard

CWS 1 @ TB 5 - Final
SEA 6 @ MIN 5 - Top 8, 2 Outs
MIL 3 @ KC 5 - Top 9, 1 Out
Next Tigers Game: Wed, May 08, 01:10 PM EDT @ Guardians
^{Last Updated: 05/07/2024 09:57:52 PM EDT}

(23M, 5'5", 200 lbs) Two weeks ago I was diagnosed with a respiratory virus, and was prescribed a 40 mg dose of prednisone (to be taken twice a day as 20mg tablets). It has been 9 days since I finished my muscle weakness, shakiness/trembling (it's particularly noticeable in my hands, heightened anxiety (which I have been treating with my usual dose of 20mg escitalopram, as well as 25mg hydroxyzine as needed), and as of today, a splitting headache. I do not experience headaches frequently-- I used to have chronic migraines (from childhood to about 3 years ago) which have been permanently eliminated by taking topiramate. I have been taking Excedrin (my first dose literally just after waking), but the headache returns after it wears off. At first, I attributed my symptoms to post-viral syndrome, but after experiencing a massive acne breakout a few days ago and attributing it to prednisone, it occurred to me that my doctor did not have me taper, and it had completely skipped my mind to do so. Given that I wasn't on a very high dose and for such a short amount of time, I assume that not tapering was completely safe, but I can't help but wonder if what I'm experiencing might be a withdrawal, rather than an after-effect of the virus. Is this a possibility?

Top of the Day for 08/05/2024

^{[FAQ](https://www.reddit.com/TopOfThe/comments/dtlta2/mod_post_info_and_faq/} Discord GitHub)
^{Times shown are in UTC and dates are formatted as Day/Month/Year.
On mobile you can scroll and slide the tables to reveal more info.}

Most Upvoted Posts of the Day

Place	Title	Author	Subreddit	Score	Posted
1st	My elderly mother doesn't want to move, she is now surrounded by new townhouses in all directions.	u/KPexEA	pics	141,439 Upvotes	07/05/2024 01:34 UTC
2nd	Understandable	u/Hendo_PC	MadeMeSmile	48,818 Upvotes	07/05/2024 14:07 UTC
3rd	Observational beehive inside the house	u/nerfednani	Damnthatsinteresting	47,430 Upvotes	07/05/2024 06:01 UTC
4th	meirl	u/Malagron	meirl	43,937 Upvotes	07/05/2024 14:23 UTC
5th	Choose your fighter	u/No-Pizza-6585	Funnymemes	35,293 Upvotes	07/05/2024 02:16 UTC

Most Upvoted Comments of the Day

^{Note: These may not be entirely accurate. Currently these are out of the comments taken from the top 5 submissions.}

Place	Body	Author	Subreddit	Score	Posted
1st	I’m sure the birds also really don’t want your mother to move. They need some trees	u/theblackyeti	pics	19,207 Upvotes	07/05/2024 02:14 UTC
2nd	There is a guy in miami that has buildings all around his property. He would not move. The city harrasses the hell out of him for every little thing they can so he moves.he is holding out on them.	u/BSARIOL1	pics	14,747 Upvotes	07/05/2024 02:39 UTC
3rd	Do NOT let her purchase large numbers of balloons or answer the door to Boy Scouts.	u/yoyogogo111	pics	12,046 Upvotes	07/05/2024 02:07 UTC
4th	Looks like a great neighborhood. She gets her own nice plot of land and everyone else gets an upzoned neighborhood.(...)	u/bombayblue	pics	11,926 Upvotes	07/05/2024 01:40 UTC
5th	Thats badass I wouldnt move either	u/TheSwimMeet	pics	9,050 Upvotes	07/05/2024 01:41 UTC

So i switched from focalin to generic methylphenidate 20 mg er last week. And the first 5 days it worked well. But today right before taking the pill i ate popoyes ( fried chicken) and today it felt horrible no bad side effects but i could barely focus and i felt before like when i was unmedicated.
Any similar experiences. Are fried food acidic and afect the absorption of methylphenidate? I read that it affects aderall , but i have not found anything that suggets that it affects methylphenidate.

I'm so desperate for answers so I will try to be as detalied as possible.
25 male, exercised regularly, worked 40-50 hours a week. Started having some issues back in September. Had some random panic attacks, they would start with tingling in my hands and feet and eventually work its way up into my face and cause me to go into a full panic mode. Some days I would wake up cold as hell and with low blood pressure. That would also put me into a state of panic. Had blood tests ran, heart monitor put on. Nothing could be found. It eventually got better, would still have those mornings where I would wake up cold but those were hit or miss.
Fast forward to February, I have the opportunity of a lifetime (to me anyways). Go on my first ever cruise. This would also mark my first time flying. I was super excited but super nervous, due to the health issues I had experienced in prior months. I debated on not going at all, but eventually decided to go since my ticket was free and I just had to pay for the flight. It was a full week cruise.
I honestly was miserable for most of it. The first two nights we ran into some rough weather and the boat rocked like hell. It put me into yet another panic attack while I was trying to sleep. Since I couldn't see what was happening (our room had no windows) it made everything worse.
After getting off the cruise ship that Friday, and checking into a hotel room for the afternoon until our flight later that night, I've had a non-stop rocking sensation. This would later be followed by a strong pulling sensation when I laid down to try and sleep, it scared the shit out of me. Afger doing research, i was convinced i had MDDS. When we got home, I booked an appointment with a neurologist who specializes in Vestibular issues and was diagnosed with Vestibular Migraine as well as MDDS.
I am posting in here because for the last month I've developed 24/7 vertigo and cannot figure out why. It's like I'm back on the boat at times. Everything in my vision moves up and down or side to side. I am currently on venlafaxine 75 MG and have almost finished being on this dose for a full month. I'm becoming more depressed as this goes on because I've lost all enjoyment in my life. I can't play video games like I used to. I can't workout due to the vertigo. I'm gaining weight and am honestly not seeing the point in life anymore if this is what I have to deal with for 24 hours a day, 7 days a week.
Does anybody have any recommendations for me? I'm doing VOR therapy, but that doesn't seem to be helping at all.