Advanced pharmacology for nurse practitioners

White Coat Investor - Helping physicians avoid financial mistakes and build wealth since 2011.

2018.06.26 20:05 WCInvestor White Coat Investor - Helping physicians avoid financial mistakes and build wealth since 2011.

This subreddit is a place where high income professionals of all types can ask, answer, discuss, and debate the personal finance and investing questions specific to our unique situations without being criticized, ostracized, or downvoted simply for having a high income and "first world" problems. This includes physicians, dentists, attorneys, physician assistants, nurse practitioners, pharmacists, physical therapists, occupational therapists, and others with high incomes.
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2013.03.03 22:51 Epidoodle CRNA

A place to discuss Nurse Anesthesia.
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2020.10.18 02:03 For future APRNs and APRN students

A place for prospective nurse practitioners.
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2024.05.19 11:46 PEPSIPANDORALUNA BOTCHED FILLERS & HYALURONIDASE DAMAGE

It has taken me more than 8 years to finally feel comfortable and confident to post a review about Gavin Chan. In 2015 I went to the Victorian Cosmetic Institute & was talked into having 4mls of filler injected into my cheeks & nasolabial folds to lift my cheeks by self appointed “cosmetic medicine specialist” Dr Somaiye Kadivar. I was told that the filler was temporary & would last anywhere between 12-18 months.
Once the procedure was over I looked in the mirror & noticed one cheek was higher while the other cheek was lower & further out from my nose. My nasolabial folds were arched, crooked, unnatural & everytime I smiled my cheeks would pop out like golf balls. I hated the results because the filler added volume instead of a lift like I was led to believe.
Just the thought of what I would have looked like if I had gone ahead with the 12 month "alternative treatment plan" devised by the “cosmetic medicine specialist" Dr Somaiye Kadivar who recommended 12mls of filler costing me over $9,000 and 60 units of Botox every 3 months for $720 per treatment gives me nightmares.
Soon after I contacted the owner of the Victorian Cosmetic Institute Gavin Chan and complained about the botched filler. He assured me it was easily & instantly reversible by injecting Hyaluronidase which is used off label to dissolve fillers. After several attempts over the coming days & weeks it was quite obvious that the filler was still present.
On one occasion Gavin Chan dissolved my tear troughs via the cheeks yet I never had filler in my tear troughs to begin with. On another occasion while injecting Hyaluronidase he also started to inject filler into my temple without prior warning. When I asked him why he was injecting my temple he told me he was compensating me for my troubles yet never mentioned that the temple is a danger zone & a risky area to inject.
In total I had 6mls of filler injected into my face within 19 days, yet on the Victorian Cosmetic Institute's website it states that 1ml of filler is enough for the entire face. On each occasion Gavin Chan never informed me of the risks, dangers & complications associated with Hyaluronidase & never gave me a consent form to read and sign.
A few years later I had a consultation with Professor Mark Ashton who is an expert in filler complications & he told me that if the filler hadn't dissolved by now then it was permanent. He gave me a referral for an MRI of the head which detects the exact amount of filler & the exact location of the filler. The MRI report stated that I still had upto 4mls of filler in my face even after all the dissolving sessions from many years ago.
On Dec 3rd 2018 I showed Gavin Chan my MRI results who had no idea at the time that MRI scans can detect fillers. His recommendation was more dissolving but in a larger dose so he flooded my face with Hyaluronidase yet never recorded the amount in my clinical notes. When I went back for a follow up consultation on Dec 10th 2018 he contacted radiologist Mobin Master in my presence who also appeared not to be aware at the time that MRI’s can detect filler but suggested I get another MRI anyway.
Not long after, Gavin Chan contacted me via email thanking me for bringing the MRI information to his attention instead of thanking Professor Mark Ashton who he had previously corresponded with via email regarding my MRI results. For some unknown reason it did not occur to Gavin Chan that Professor Mark Ashton deserved all the credit for having known all along that MRI’s can detect dermal filler.
Instead Gavin Chan chose to capitalise on this information by making a YouTube video claiming he had made this discovery after doing quite a few MRI's (not sure how this is possible as he is not a radiologist). He also stated in his email that he wanted to inject a very high dose of Hyaluronidase to try and dissolve the filler again for the 5th time.
In the meantime I noticed that my facial structure had collapsed, I developed deep hollows under my eyes, my cheeks caved in, my marionette lines were deep, long & dragged down. The corners of my lips sunk into my mouth & my skin was extremely loose, saggy & stretchy all the way down to my neck.
Hyaluronidase did not dissolve my fillers but instead permanently dissolved my connective tissue as it can't distinguish between the skin's own HA & the HA in dermal fillers. Hyaluronidase has aged my facial features by 10 years & only a full facelift & necklift can fix this.
In 2019 & 2020 I took Gavin Chan to VCAT, a small claims court requesting a refund & a corrective advertising order because his website falsely advertised that the temporary fillers they use last anywhere between 12-18 months. Gavin Chan was granted lawyers on the grounds that his business reputation was at stake while I had to represent myself.
I cross examined him with over 90 questions & I presented over 100 pages of supporting evidence & documentation while he only had photos & amended clinical notes. Mobin Master was also present in court supporting Gavin Chan. The hearing was held over 2 days & my claims were eventually dismissed by the judge.
Gavin Chan who “specialises” in cosmetic procedures got away with not providing a patch test for Hyaluronidase and not providing a consent form for Hyaluronidase on each occasion amongst other things.
Mobin Master who began posting the first MRI images on his Instagram account 1 week after the first VCAT hearing in Nov 2019 now identifies as an “aesthetic radiologist” and a “world pioneer” in filler longevity.
Gavin Chan, the self appointed “doctor trainer” for various dermal fillers and anti-wrinkle injections and “cosmetic surgeon” as he once claimed to be isn’t even a GP, he is just a medical practitioner with no other formal training. His only qualification is a Bachelor of Medicine/Bachelor of Surgery with a “background in intensive care, anaesthesia and emergency medicine.
Gavin Chan who medically reviews his own articles has provided cosmetic procedures such as anti-wrinkle injections, dermal fillers, liposuction, facial fat transfers, skin needling and laser treatments since 2004 and has held advanced one-on-one injector training workshops for dermal fillers yet has no certificates or credentials listed on his Victorian Cosmetic Institute’s website.
In my opinion Gavin Chan has a special interest in portraying himself as the master of cosmetic injectables in an unregulated industry. He is an injectable junkie, obsessed with the syringe & makes no apologies for ruining my life. I hold Gavin Chan responsible for destroying my looks and my life.
In late 2023 I was threatened on 2 occasions with legal action for posting Google reviews on Gavin Chan. His lawyers instructed me to remove each review within 7 days otherwise I would be sued for defamation in the Federal Court of Australia. I wasn't even given a chance to respond to each email when my reviews were both taken down.
I have no doubt in my mind that Gavin Chan was behind the removal of my reviews. In my opinion, Gavin Chan pays a lot of money to have my reviews removed as he doesn't want anyone finding out about me and the truth about him.
I challenge Gavin Chan to explain to the general public, his patients and to his social media followers what he actually means by "background in intensive care, anaesthesia, and emergency medicine" as well as publicly display all his credentials on social media (qualifications, certificates and training) in anaesthesia, liposuction & cosmetic procedures such as cosmetic iniectables & laser treatments.
Update: In early 2024 I received further threats from Gavin Chan's lawyers for posting this Reddit review and a RealSelf review regarding my personal experience and results. “Articles medically reviewed by Dr Gavin Chan" & " Dr Gavin Chan has a background in intensive care, anaesthesia, and emergency medicine" have since been quietly removed from the Victorian Cosmetic Institute website.
If you are a cosmetic injectable victim or want to be well informed regarding what can go wrong please join BOTCHED FILLERS & HYALURONIDASE DAMAGE SUPPORT GROUP on FB.
submitted by PEPSIPANDORALUNA to u/PEPSIPANDORALUNA [link] [comments]


2024.05.19 10:50 Lotoalofafaavauvau My psychiatrist won’t let me try lamictal

First time poster. I have bipolar 1 with psychotic features. I have been medicated for over a decade on a low dose of Tegretol, lithium and clonazepam. I can’t tolerate higher doses but this regime does prevent full blown mania and psychosis.
I have suffered severely for all these years this fluctuating between up and down swings despite trying every med Dr.’s can think of. I desperately need something I can use to stop the mania and the insomnia that goes with it. Every episode is a battle to keep in control, a battle I usually lose with torturous consequences.
I have been asking to try lamictal now for 6 months and the Dr., well nurse practitioner, keeps putting it off. He told me yesterday that it’s “only for depression; it doesn’t treat mania.” I responded that it’s a mood stabilizer, like Tegretol, and I was under the impression it treated both.
He also said because I am alternating my Tegretol dose every other day he won’t let me try lamictal. I am alternating every other day because they don’t offer the dose I can tolerate which is 250 mg. He hates that I do that and is getting frustrated with me. Any lower and my psychosis starts creeping in. Any higher and I get debilitating GI issues. I was devastated to hear him say I could not try it and postponed it for the 4th time.
He also says despite me being on a super low Tegretol does I would be doubling my risk of Steven Johnson’s syndrome (the deadly rash).
He won’t let me take Tegretol and lamictal together because he says he won’t know which one caused the rash, (if I were to get it) but I’ve been on Tegretol for over a decade with no rash.
The question: is lamictal just for bipolar depression? Does it not curb mania? Is he overreacting regarding the risks? Is his frustration founded regarding me taking the every other day alternating dose? I do that to cope with the fact that they don’t make the dose I need to stay sane enough; it’s not for fun.
I was ready to brave another med trial, which is usually debilitating for me. When my brain is active, which is now, i am able to try new meds. When I am down I am not. I desperately need more medication and he’s basically stringing me along while I am barely keeping it together between mania and the insomnia that comes with it.
When I’m down again, he says he may let me try it, if I promise to only take Tegretol 200 every single day, never going to 300mg even if I feel I need extra to sleep or whatever. Is that too strict or is it reasonable?
I do appreciate a lot of things about him and there is a provider shortage where I live so finding a good alternative doesn’t seem likely. He does seem to get easily stressed and frustrated, seems he’s overworked right now.
I am venting a bit but any thoughts or advice is welcome. 🙏
submitted by Lotoalofafaavauvau to BipolarReddit [link] [comments]


2024.05.19 10:22 alexa_tuning [ AVAILABLE ] Guidelines for Nurse Practitioners in Ambulatory Obstetric Settings 3rd Edition Third Edition by Kelly D. Rosenberger, Nancy Cibulka, Mary Lee Barron Textbook Ebook PDF reddit. Publisher: Springer Publishing. eText ISBN 9780826148544 ISBN-13: 9780826148452

TITLE : Guidelines for Nurse Practitioners in Ambulatory Obstetric Settings 3rd Edition Third Edition by Kelly D. Rosenberger, Nancy Cibulka, Mary Lee Barron Digital Textbook Ebook PDF Download Reddit
AUTHORS : Kelly D. Rosenberger, Nancy Cibulka, Mary Lee Barron
EDITION : 3rd Edition - Third Edition
PUBLISHER : Springer Publishing
Feel free to message or Send me a chat request on Reddit / Discord / Email if you need the Textbook Pdf
Discord ID: textbookfinder#1311
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Original Textbook Cover Photo: https://postimg.cc/ykrTkhhw
Thank you :)
submitted by alexa_tuning to FindMyTextBookForMe [link] [comments]


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2024.05.19 09:51 Alioliou Thaumical precious metal alloys in my world

Thaumical precious metal alloys in my world
My world of fantastic science fiction is based on the real world, but with the addition of magic and thaumaturgy as an additional powerful branch of arts and techniques.
The historical course of my world is similar to the historical course of the real world, but there are sciences derived from magic. Runic engineering studies the interaction of glyphic circuits and geometric shapes imbued with magic with reality. Thaumaturgy and the science of aspects study the converging aspects of matter and its manipulation to obtain new materials and artifacts without classical chemical formulas. Arcanology studies the functioning and principles of so-called spells, incantations, and enchantments. Etcetera.
Science predominates overall, and while it has taken some time, it has swallowed magic, at least partially. There are still many things unknown about the functioning of magic. There are many things that work and have been obtained through trial and error, but whose intrinsic mechanisms are unknown. There are hypotheses derived from quantum physics, of course, but unconfirmed, or impossible to confirm.
But that's not the point.
In my world, just like in the real world, metallurgy has played a very important role. Without metallurgy, we wouldn't have weapons, machines, computing, electricity... we wouldn't have many things. Without metallurgy, they wouldn't have them either, and they wouldn't have thaumaturgy or many enchanted objects they employ.
Within the vast domain of thaumic metallurgy, the most prominent metals are undoubtedly the precious metals: copper, silver, and gold. Throughout the history of my world, these three metals have held an undisputed position of relevance in thaumaturgy. While iron and mercury have also been employed in thaumaturgic practice (the Thaumonomicon, one of the oldest works on thaumaturgy known, mentions thaumium and alchemical brass, two magical metals derived from iron), copper, silver, and gold have demonstrated unparalleled enchantability and magical versatility.
These precious metals have not only been used in the creation of magical objects throughout history but have also been the subject of numerous alchemical experiments in transmutation and aspectual manipulation, although most of these attempts have been largely unsuccessful and have sometimes led to unintended consequences.
In recent times, there has been a growing interest in the use of other precious metals such as platinum, rhodium, and osmium in thaumaturgy. However, this interest is still in its nascent and limited stage compared to the study and practice related to copper, silver, and gold. Thaumaturgy related to these less conventional metals is still to be fully developed, and their magical potential is far from fully understood.

The three main precious metals of interest

Copper has been a frontline choice in creating alloys that function as conductors and catalysts of magic throughout the ages, thanks to its impressive capacity to be enchanted. Furthermore, it stands out for its resistance to aspectual essences and its ability to act as an effective aspectual insulator. Even in ancient times, bronze armor decorated with primitive runes and magical glyphs not only rivaled but surpassed the resilience and tenacity of the finest steel armor of the later medieval period.
Today, this metal remains relevant in the creation of alloys such as molybdocopper, orichalcum, hepatizon, and manganin, which are used in the manufacturing of special munitions. These bullets, engraved with specific enchantments, acquire attributes and particular effects that make them highly effective in a wide variety of situations. The versatility of copper as a magical material makes it a valuable and sought-after option for practitioners of magic and thaumaturgy worldwide.
Silver, on the other hand, also stands out for its capacity to store magic. It has been employed in various ways in the realm of thaumaturgy and magic. One of its most prominent applications is its use in coating weapons and armor made of steel. Silver can be fused with this material to enhance the enchantments present in the weapons and armor, or even to directly manufacture weapons and armor imbued with its own magical properties.
Furthermore, silver has traditionally been associated with protection against supernatural entities and has been used to create a wide variety of protective amulets and talismans. Its teratocidal properties make it an essential component in the manufacturing of specialized weapons and ammunition designed for the hunting and elimination of creatures such as therianthropes, demons, and other supernatural beings. The famous silver bullets are an iconic example of this type of ammunition, known for their effectiveness in confrontations against beings of malign or magical nature. Silver, with its versatility and magical power, has earned a prominent place in the arsenal of magic practitioners and thaumaturges worldwide.
Gold, on the other hand, stands out as one of the most suitable metals for enchantment and magic absorption. Despite these qualities, its use in thaumaturgy has been limited due to its scarcity, high value, and the difficulty in stabilizing its magical properties. Creating enchanted objects from gold requires highly advanced and stabilized infusion altars, or the use of very specific alloys that can enhance its magical manipulation.
Despite these limitations, various gold alloys have sparked special interest among thaumaturges and alchemists worldwide. Below, we will detail some of these alloys, exploring their unique characteristics and potential applications in the field of magic and thaumaturgy.
Copper, silver and gold...

Tychereal gold

Tychereal gold encompasses a set of gold alloys that possess the unique property of influencing the luck of the bearer. This capability is achieved through the infusion of the "probabilitas" aspect into the alloys or through the inscription of specific enchantments. However, it is important to note that the effect on the bearer's luck is subtle.
In certain regions of Central, Southern, and Eastern Asia, red gold alloys, which contain a high copper content, are employed for this purpose because culturally, the color red is believed to bring good luck in these areas. These alloys, when enchanted or infused with "probabilitas," appear to have a greater impact on the bearer's luck, although their effect is temporary and tends to fade over time. Additionally, these alloys are prone to mild oxidation and corrosion, leading to the loss of their desired tychereal property.
However, the most effective tychereal alloy is known as "leprechaun gold," invented in Ireland during the Middle Ages. Leprechaun gold is a lime-green-toned alloy, primarily composed of gold with additions of silver and tin, along with traces of cadmium, and with high amounts of "probabilitas" aspect. Although scientific trials have shown that this alloy has a significant and generally positive impact on the bearer's luck, it presents a serious contraindication: cadmium, a heavy metal known to be toxic and carcinogenic.
Leprechaun gold, a tychereal gold alloy invented in Ireland.

Royal thaumium

Royal thaumium, a distinguished and valuable alloy, differs from common thaumium, ancient thaumium or, simply, thaumium (an amalgam of wrought iron impregnated with praecantatio). This exceptional compound is a combination of gold and aluminum impregnated with praecantatio.
By fusing gold with aluminum in an approximate mass ratio of 79:21, purple gold is obtained, a brittle intermetallic compound with an intense magenta color. When this purple gold is impregnated with large amounts of praecantatio, it becomes royal thaumium.
The term "royal" in its name is attributed to its high production cost and its original association with royalty and divinity. Although it shares similarities in appearance and qualities with thaumium based on iron, the properties of royal thaumium are even more pronounced. It can store approximately 53 times more magic than iron-based thaumium, acts as an extremely impermeable aspectual insulator to essences, and possesses a tremendous enchanting capacity. However, it is important to note that royal thaumium is extremely fragile compared to its iron-based counterpart.
Royal thaumium was initially discovered and crafted by alchemists in the late 18th century when the first samples of aluminum were successfully extracted, which at that time were considerably more expensive than gold due to the difficulty of obtaining it. During the early to mid-19th century, this alloy was widely used in the manufacturing of cores for high-power magic wands. Although it has been replaced by more economical thaumic materials today, royal thaumium is still appreciated in certain classic magic circles, acquired by purists and collectors of magical objects.
Royal thaumium, derived from purple gold, an intermetallic compound.

Aurallium

Within the realm of modern metallurgy, quasicrystals have emerged as structural forms that, unlike conventional crystals, are ordered but not periodic. Most quasicrystals discovered to date are metallic and exhibit symmetries that defy traditional crystalline conventions, such as decagonal and icosahedral shapes.
These quasicrystals are particularly intriguing in the field of thaumaturgy due to their ability to harbor large densities of a degenerate form of the "ordor" aspect, known as "auratio."
Among the most relevant quasicrystals in thaumaturgy are dodecaedrites, quasicrystalline alloys generally composed of aluminum or rare earth metals, infused with huge amounts of praecantatio. These dodecaedrites have the capacity to store massive amounts of magic, surpassing conventional thaumic alloys by thousands of times, making them ideal for the manufacturing of high-powered magical objects and disruptive antimagic munitions.
The term "aurallium" refers to a group of dodecaedrite-based alloys of gold quasicrystals, such as the gold-gallium-terbium alloy AC and other alloys M,X)85.7RE14.3 (M = Ag, Au, X = Al, Ga, In, RE = Er, Lu). However, the most notable of these alloys is "pure aurallium," composed of pure gold impregnated with large amounts of "auratio" aspect essence. This material forms dodecahedral, icosahedral, and tricontahedral crystals of a pale orangish-golden hue with celestial blue highlights.
Pure aurallium is metastable, meaning its quasicrystalline structure can collapse under certain extreme conditions to form amorphous gold, releasing energy and magic in the process. Additionally, this alloy has the ability to induce ordering and crystallization of surrounding materials when magic is applied to it, which could be utilized for various purposes, such as manufacturing enhaced wand cores for specific spells, or negentropic weapons like the "ordor ray."
Aurallium icosahedral quasicrystal.
Nuclear tests conducted by North Korea using this material, whose documentation has been obtained and released by the espionage forces of Acheron (an organization tasked with containing and eliminating supernatural threats), yield terrifying results. Atomic weapons doped with big amounts of aurallium generates negentropic fields that destroy all organic tissue within a radius several times larger than the blast radius and the lethal neutron radius. Animal and plant tissues liquefy and reorganize into perfectly ordered crystals of amino acids, phosphates, and carbohydrates imbued with high-purity aspect essences that may continue reacting dangerously with the environment, potentially producing flux, taint seeds and void gaps. All exposed rock and metal recrystallize into large amalgams of pure single crystals of various pure materials, forming ordered giant minimalist structures. And exposed water is aetheralized into pure aqua aspect that permeates and destructively alters any exposed material.
Surprisingly, despite the high thaumaturgy and technology involved in the production of pure aurallium and aurallium alloys, traces of aurallium have been found in well-preserved ancient legendary artifacts of high power, although the origin of such traces of aurallium is likely accidental or non-conciouss, this explains some of the astonishing qualities of these arcane artifacts.
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2024.05.19 09:36 Yuvraj_Atlas Social Media Marketing Courses In Dubai

IIDE (Indian Institute of Digital Education) is a prominent institute known for its comprehensive courses in digital marketing and related fields. They offer a variety of programs catering to different levels of expertise, from beginners to advanced practitioners. The institute is well-regarded for its industry-relevant curriculum, experienced faculty, and practical approach to learning.
IIDE offers a specialized Social Media Marketing Course that is available online, making it accessible to learners in Dubai and worldwide. This course is designed to equip students with the skills and knowledge needed to excel in social media marketing. Here’s a detailed look at what the course typically includes:

Social Media Marketing Course Details

Duration:

Curriculum:

  1. Introduction to Social Media Marketing:
    • Overview of social media marketing and its importance.
    • Understanding the social media landscape.
  2. Content Creation and Strategy:
    • Developing effective social media content strategies.
    • Content planning, scheduling, and management.
    • Visual and written content creation best practices.
  3. Platform-Specific Strategies:
    • Facebook: Organic and paid strategies, page management, and Facebook Ads.
    • Instagram: Content creation, growth strategies, Instagram Ads.
    • Twitter: Building a Twitter presence, tweet strategies, Twitter Ads.
    • LinkedIn: Professional networking, LinkedIn for business, LinkedIn Ads.
    • YouTube: Video marketing, channel optimization, YouTube Ads.
    • Other Platforms: Emerging social media platforms and their potential.
  4. Community Management and Engagement:
    • Building and nurturing an online community.
    • Best practices for engagement and customer interaction.
  5. Social Media Advertising:
    • Creating and managing social media ad campaigns.
    • Understanding ad targeting and budget allocation.
    • Measuring ad performance and ROI.
  6. Analytics and Reporting:
    • Using social media analytics tools.
    • Interpreting data to make informed decisions.
    • Reporting on social media performance.
  7. Advanced Strategies:
    • Influencer marketing.
    • Social media for e-commerce.
    • Crisis management on social media.

Features:

How to Enroll:

Additional Support:

This course is ideal for marketers, business owners, and anyone looking to enhance their social media marketing skills. The flexibility of online learning makes it accessible to individuals in Dubai, allowing them to learn from top industry professionals without geographical constraints.
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2024.05.19 09:15 maquinas501 Dr. Tyrone Malloy Unveils $1,000 Scholarship to Support Future Medical Leaders

The Dr. Tyrone Malloy Scholarship offers a $1,000 award for undergraduate students passionate about women's health, providing a competitive advantage in pursuing medical careers.
The Dr. Tyrone Malloy Scholarship is important as it provides financial support and recognition to deserving individuals, fostering a new generation of healthcare practitioners dedicated to advancing women's health and upholding the highest standards of patient care. This initiative aims to empower and inspire the next generation of medical professionals, ensuring a community of healthcare practitioners committed to excellence and ethical medical practice. The scholarship also serves as a beacon for aspiring medical professionals seeking to make meaningful contributions to the field.
Read More https://newsramp.com/curated-news/dr-tyrone-malloy-unveils-1000-scholarship-to-support-future-medical-leaders/9ddec93d990898f4e57c88083c4b45d4
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2024.05.19 08:22 Very-Gnaughty Disability rating

I just spent a couple hours reading through the knowledge sub and a ton of posts from vets increasing to 100% and receiving a ton of back pay. One post the vet said he received his initial rating and just stuck with it for a while. Unfortunately none of these posts really talked about how this happened.
Am I currently in that boat? How do I know if my rating is accurate, or if I should fight/file for an increase? Looking for any recommendations or knowledge to help. The C&P exams around me are a joke, usually performed my a nurse practitioner in 15 minutes and mainly verbal. After finding this page now I’m not sure if my rating is accurate.
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2024.05.19 07:34 Ayeitsgreeksea How do I(21F) heal from my first love(23M)? Will it ever get better?

Hello Reddit, I never post and I usually just read fellow stories but I could really use some advice and apologies in advance for bad writing(I’m in a bad state):
I(21F) dated my ex(23M) for two years. We met during covid through mutual friends that were dating. I poured a lot of effort into our relationship and I still care him very much. He initiated the break up after I told to him about wanting better communication because he was becoming distant and he says he felt bad about all the pain he caused me and wanting to attend nursing school saying he wouldn’t have time. It was very abrupt and I haven’t handled it well at all because it was a big decision I didn’t get to be involved in making. I know it sounds stupid and he hurt me a lot but I’ve never been this close to someone before so it has been the most painful experience for me.
For some backstory on me: I live a very isolated life. Before meeting my best friend and him I had no one to talk to. I would open up to her however she is currently going through so much with her dad’s aggressive cancer diagnosis and I don’t want to burden her any further. I’ve been struggling alone for a long time and have also been dealing with bad depression my whole life. I lost more than just my relationship since then. In a way this is my last desperate attempt for help. I had never felt happy in life before meeting him and he has helped me so much in life. I hate living isolated again, I don’t want to be sad all the time and I don’t want to feel guilty for wanting to heal. I feel like I’m cheating or being disloyal. But I genuinely loved caring for someone so much.
Is there any advice that could help me heal? Thank you to those who do read this and have advice I am grateful for any words.
(There is some information left out that I’d be happy to fill in if needed)
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2024.05.19 06:56 NeuronsToNirvana Figures; Conclusions; Future directions Hypothesis and Theory: Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies Frontiers in Pain Research: Non-Pharmacological Treatment of Pain [Apr 2024]

Figures; Conclusions; Future directions Hypothesis and Theory: Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies Frontiers in Pain Research: Non-Pharmacological Treatment of Pain [Apr 2024]
Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and mini-systems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain.

Figure 1

https://preview.redd.it/zgpjyihsdb1d1.jpg?width=945&format=pjpg&auto=webp&s=6ec6f8e4cab44213aa6330998ba8febd85f5315a
Proposed schematic representing interacting components and mini-systems. Central arrows represent multidirectional interactions among internal components. As incoming data are processed, their influence and interpretation are affected by many system components, including others not depicted in this simple graphic. The brain's predictive processes are depicted as the dashed line encircling the other components, because these predictive processes not only affect interpretation of internal signals but also perception of and attention to incoming data from the environment.

Figure 2

https://preview.redd.it/e9g8b5stdb1d1.jpg?width=1056&format=pjpg&auto=webp&s=83febb37a610bb6b01c5cec42be127b1dd72d7b3
Proposed mechanisms for acute and long-term effects of psychedelic and mindfulness therapies on chronic pain syndromes. Adapted from Heuschkel and Kuypers: Frontiers in Psychiatry 2020 Mar 31, 11:224; DOI: 10.3389/fpsyt.2020.00224.

5 Conclusions

While conventional reductionist approaches may continue to be of value in understanding specific mechanisms that operate within any complex system, chronic pain may deserve a more complex—yet not necessarily complicated—approach to understanding and treatment. Psychedelics have multiple mechanisms of action that are only partly understood, and most likely many other actions are yet to be discovered. Many such mechanisms identified to date come from their interaction with the 5-HT2A receptor, whose endogenous ligand, serotonin, is a molecule that is involved in many processes that are central not only to human life but also to most life forms, including microorganisms, plants, and fungi (261). There is a growing body of research related to the anti-nociceptive and anti-inflammatory properties of classic psychedelics and non-classic compounds such as ketamine and MDMA. These mechanisms may vary depending on the compound and the context within which the compound is administered. The subjective psychedelic experience itself, with its relationship to modulating internal and external factors (often discussed as “set and setting”) also seems to fit the definition of an emergent property of a complex system (216).
Perhaps a direction of inquiry on psychedelics’ benefits in chronic pain might emerge from studying the effects of mindfulness meditation in similar populations. Fadel Zeidan, who heads the Brain Mechanisms of Pain, Health, and Mindfulness Laboratory at the University of California in San Diego, has proposed that the relationship between mindfulness meditation and the pain experience is complex, likely engaging “multiple brain networks and neurochemical mechanisms… [including] executive shifts in attention and nonjudgmental reappraisal of noxious sensations” (322). This description mirrors those by Robin Carhart-Harris and others regarding the therapeutic effects of psychedelics (81, 216, 326, 340). We propose both modalities, with their complex (and potentially complementary) mechanisms of action, may be particularly beneficial for individuals affected by chronic pain. When partnered with pain neuroscience education, movement- or somatic-based therapies, self-compassion, sleep hygiene, and/or nutritional counseling, patients may begin to make important lifestyle changes, improve their pain experience, and expand the scope of their daily lives in ways they had long deemed impossible. Indeed, the potential for PAT to enhance the adoption of health-promoting behaviors could have the potential to improve a wide array of chronic conditions (341).
The growing list of proposed actions of classic psychedelics that may have therapeutic implications for individuals experiencing chronic pain may be grouped into acute, subacute, and longer-term effects. Acute and subacute effects include both anti-inflammatory and analgesic effects (peripheral and central), some of which may not require a psychedelic experience. However, the acute psychedelic experience appears to reduce the influence of overweighted priors, relaxing limiting beliefs, and softening or eliminating pathologic canalization that may drive the chronicity of these syndromes—at least temporarily (81, 164, 216). The acute/subacute phase of the psychedelic experience may affect memory reconsolidation [as seen with MDMA therapies (342, 343)], with implications not only for traumatic events related to injury but also to one's “pain story.” Finally, a window of increased neuroplasticity appears to open after treatment with psychedelics. This neuroplasticity has been proposed to be responsible for many of the known longer lasting effects, such as trait openness and decreased depression and anxiety, both relevant in pain, and which likely influence learning and perhaps epigenetic changes. Throughout this process and continuing after a formal intervention, mindfulness-based interventions and other therapies may complement, enhance, and extend the benefits achieved with psychedelic-assisted therapies.

6 Future directions

Psychedelic-assisted therapy research is at an early stage. A great deal remains to be learned about potential therapeutic benefits as well as risks associated with these compounds. Mechanisms such as those related to inflammation, which appear to be independent of the subjective psychedelic effects, suggest activity beyond the 5HT2A receptor and point to a need for research to further characterize how psychedelic compounds interact with different receptors and affect various components of the pain neuraxis. This and other mechanistic aspects may best be studied with animal models.
High-quality clinical data are desperately needed to help shape emerging therapies, reduce risks, and optimize clinical and functional outcomes. In particular, given the apparent importance of contextual factors (so-called “set and setting”) to outcomes, the field is in need of well-designed research to clarify the influence of various contextual elements and how those elements may be personalized to patient needs and desired outcomes. Furthermore, to truly maximize benefit, interventions likely need to capitalize on the context-dependent neuroplasticity that is stimulated by psychedelic therapies. To improve efficacy and durability of effects, psychedelic experiences almost certainly need to be followed by reinforcement via integration of experiences, emotions, and insights revealed during the psychedelic session. There is much research to be done to determine what kinds of therapies, when paired within a carefully designed protocol with psychedelic medicines may be optimal.
An important goal is the coordination of a personalized treatment plan into an organized whole—an approach that already is recommended in chronic pain but seldom achieved. The value of PAT is that not only is it inherently biopsychosocial but, when implemented well, it can be therapeutic at all three domains: biologic, psychologic, and interpersonal. As more clinical and preclinical studies are undertaken, we ought to keep in mind the complexity of chronic pain conditions and frame study design and outcome measurements to understand how they may fit into a broader biopsychosocial approach.
In closing, we argue that we must remain steadfast rather than become overwhelmed when confronted with the complexity of pain syndromes. We must appreciate and even embrace this complex biopsychosocial system. In so doing, novel approaches, such as PAT, that emphasize meeting complexity with complexity may be developed and refined. This could lead to meaningful improvements for millions of people who suffer with chronic pain. More broadly, this could also support a shift in medicine that transcends the confines of a predominantly materialist-reductionist approach—one that may extend to the many other complex chronic illnesses that comprise the burden of suffering and cost in modern-day healthcare.

Original Source

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2024.05.19 06:32 Ok_Swimmer_1993 Time of death for my marriage?

I (31F) have been married to my (32M) husband for 6 years, we have been together for 10. We seem to continuously have the same argument, he is not emotionally available for me and I am too "needy" and "sensitive" to him. I complain about this often, as I have felt neglected and unloved for a while now. We sometimes talk about things and then our lives get better until they decline again, this has been the same cycle for years now. I often try things to get him to open up and be more considerate not just for the sake of our relationship but for the world, he can be pretty mean and is definitely a hot head which creates issues with family and work. I purchased a deck of card that has relationship questions to deepen your connection with you sig oth and he reluctantly agreed to play with me, after 4 questions or so, he just gave short answers and at the end he just "couldn't think of anything", this really hurt my feelings as this was a question regarding how he felt about me now versus when we first started dating, I told him this upset me, and he shut down, i started crying and told him I didn't want to keep playing the game. This was a week ago or so. I just let it go and moved on. We did not talk about it. Last night, we had a bbq at a friend's house, at the end of the night everyone went home besides the host/her bf, me and my husband. We had been drinking a bit so she(the host) started thanking us for coming and telling us how happy she is we came over and how she loves us, my husband quickly started reciprocating the feelings saying he had a great night, he is so thankful for our friendship, etc, we all shared a drink and talked about the success of the evening.
Now, I feel so fucking upset over this, it was difficult to watch him express his emotions so clearly and easily to other people when I have been trying for years to get him to express his love for me in any way. I have felt disconnected from him so i have asked for some sort of confirmation of our love, a card, a recording, via text, anything really, and all I get is a shrug, or a "idk what to say", or "that feels like homework". I feel like this was my breaking point after years of trying, I have not spoken to him since last night. I am so drained I honestly don't even want to start an argument and he is an avoidant and is currently nursing a hangover.
I had considered couples counseling in the past so we can work on ways to communicate better since this is a skill I feel we both lack in. He's never been thrilled about it but said he would give it a try. After last night i dont know if my marriage is salvageable anymore. I now see he can be emotional and loving but just never towards me. Im here for an outsiders perspective, am i over reacting? I know im not perfect and have lots of issues im currently working on in therapy myself, but I'd like to feel like my home life is my safe space like it used to be. Thank you in advance.
submitted by Ok_Swimmer_1993 to CharlotteDobreYouTube [link] [comments]


2024.05.19 04:33 szering Input Needed! Feeding Routine + Supply

Sorry for the novella, and thanks in advance for the collective wisdom!
My LO is 6.5 weeks old and ~11 lbs 6 oz. I did a weighted feed with my LC, and she estimates LO removes 3-4 oz/feed. My largest pump in the MOTN is 4 oz.
My LO needs 4-5 oz/feed to be satisfied, eating 8 times a day. I know, that sounds like a crazy amount. To satisfy him, we top up each nursed feed and supplement with formula as needed. We pace feed and use a slow flow nipple if he is drinking from a bottle. If he doesn't get 4-5 oz, he will continue to show hunger cues (rooting, opening his mouth, smacking his lips, and finally crying inconsolably), and he will not settle down for naps or to sleep at night no matter how much we soothe him. By other metrics (weight gain, poops/day), we're not overfeeding him.
In total, based on the weighted feed and my pumped volume, I'm producing 28-32 oz/day. My LO needs 32-40 oz/day.
Here are all the things I've tried to boost supply.
  1. Not exactly triple feeding, but pumping immediately after 2-3 feeds/day (still doing this).
  2. Power pumping 1x a day for a week.
  3. Using a haakaa during every nursing session.
  4. Eating oatmeal, drinking oat milk, drinking Guinness, drinking malt ovaltine (still doing this).
In fact, there was a week where I was doing all four of these at once. Based on how much I'm pumping, my supply is not increasing at all. Literally no change in weeks.
These are my questions:
  1. Is this just what my supply is?
  2. Should I just embrace supplementing with formula and get rid of the pumps between feedings to make things more sustainable?
  3. Does anyone else's LO drink this much?
submitted by szering to beyondthebump [link] [comments]


2024.05.19 04:23 szering Input Needed! Feeding Routine + Supply

Sorry for the novella, and thanks in advance for the collective wisdom!
My LO is 6.5 weeks old and ~11 lbs 6 oz. I did a weighted feed with my LC, and she estimates LO removes 3-4 oz/feed. My largest pump in the MOTN is 4 oz.
My LO needs 4-5 oz/feed to be satisfied, eating 8 times a day. I know, that sounds like a crazy amount. To satisfy him, we top up each nursed feed and supplement with formula as needed. We pace feed and use a slow flow nipple if he is drinking from a bottle. If he doesn't get 4-5 oz, he will continue to show hunger cues (rooting, opening his mouth, smacking his lips, and finally crying inconsolably), and he will not settle down for naps or to sleep at night no matter how much we soothe him. By other metrics (weight gain, poops/day), we're not overfeeding him.
In total, based on the weighted feed and my pumped volume, I'm producing 28-32 oz/day. My LO needs 32-40 oz/day.
Here are all the things I've tried to boost supply.
  1. Not exactly triple feeding, but pumping immediately after 2-3 feeds/day (still doing this).
  2. Power pumping 1x a day for a week.
  3. Using a haakaa during every nursing session.
  4. Eating oatmeal, drinking oat milk, drinking Guinness, drinking malt ovaltine (still doing this).
In fact, there was a week where I was doing all four of these at once. Based on how much I'm pumping, my supply is not increasing at all. Literally no change in weeks.
These are my questions:
  1. Is this just what my supply is?
  2. Should I just embrace supplementing with formula and get rid of the pumps between feedings to make things more sustainable?
  3. Does anyone else's LO drink this much?
submitted by szering to breastfeeding [link] [comments]


2024.05.19 03:32 lizmcdizzzz Why did I do this to myself...

So a few weeks ago I posted about how I passed nursing lab, funds, med surg 1 and clinical with a 94% or higher which is unlike me- I'm normally a c/d/f student from high school. Anyways I think I've really found my calling with nursing. any advice from any other working moms? Some background- I have two toddlers at home, one is limited verbally and special needs. I have barely any family around to help babysit, but I get by with my husband working third shift. All of this say in June we start pharmacology and med surg 2 which are weed out classes at my school. I was offered a nurse externship at my hospital, which pays $31 an hour. The kicker? You have to work 24 hours a week. The great thing is it's very flexible. You can pick up any hours any shift and it doesn't have to be 12 hours at a time. I accepted this since I've been stay at home mom for four years and don't have any healthcare experience. The excitement is starting to wear off and the fear and regret is setting in where I'm wondering how the hell I'm gonna pull this off. The only thing that's pulling me through is knowing that my family needs this money. I need this for my résumé and to be a good nurse, and that I said that when I started school six months ago, and I somehow did it. Any advice from any other working moms in nursing school?
submitted by lizmcdizzzz to StudentNurse [link] [comments]


2024.05.19 03:08 camgirl808 Tipping a aesthetic NP

I’m getting a couple skin treatments quoted to be around 2-3k in one session and I’m going to an aesthetic NP who owns her own clinic. It’s going to be 2 different things. Should I be tipping her and if so, how much percent? I mean for 2 treatments and one being a machine gliding on my skin, I almost feel deterred to ever get expensive treatments anymore if I need to be tipping 20% or more because that’s $200 for 2k and $600 for 3k. I normally tip 20-25% on beauty services like hair, nails, non-invasive stuff, and this is the first time I’m spending a lot at an aesthetic clinic.
Is 10% still good? I never thought to tip nurses and doctors that did my facial injections and cosmetic procedures as I just treated them as medical professionals and just didn’t know if tipping was allowed? But now I’m seeing it all over the place that I should be tipping them.
Have you spent this much at a beauty clinic and if so how much did you tip? Thanks in advance for your advice
submitted by camgirl808 to beauty [link] [comments]


2024.05.19 02:49 Substantial_Echo_906 Are there resources for family who is enabling someone who is in need and refusing professional mental help?

Obviously this is not my regular account, but I need help determining what I can do to help my elderly father and his elderly wife who is experiencing extremely low quality of life since overdosing and being hospital a couple of times. This is going to be long and I’m sorry in advance, but I really need some advice and resources.
Since returning home from the hospital three years ago MIL has chosen to not get out of bed and her very elderly mother has moved out of her own Senior Independent Living facility to take care of her. This includes having to change MILs diaper because she won’t even get out of bed to urinate. She refuses to shower most days and her mother has to come her hair for her or it ends up matted. As a result the entire house smells of urine and their phones ring constantly with calls from MIL requesting food, drink, changing, and especially calls the second it is time for her scheduled prescription. Which is just Valium to my knowledge.
At first there was a nurse that came a few times a week but it was determined there was nothing medically wrong (except a bedsore that will not heal) that necessitated insurance to cover it and she refuses psychiatric help. Both being retired they are on a fixed income with no savings left.
She acquired a new doctor after being discharged from the hospital after her second overdose three years ago but he has yet to see him in person and he continues to prescribe her Valium in spite of threats he will not if she doesn’t come in and get a check up. He prescribed her anti depressants in the past but she refuses to take them as she insists she’s not depressed. In the past when MIL has wanted something additional for sleep and my dad and her mother refuse she becomes hysterical and verbally abusive. They are afraid of her and are enabling her as a result. Emergency services have been called before but as soon as they get there she drops the hysteria, becomes lucid, and without any actual medical issues cannot take her against her will.
My dad has fallen into depression and her own mom’s health is rapidly declining. Neither are emotionally or mentally equipped to reach out and find out what their options are. I have considered contacting adult social services ( there was an open case after discharge but nothing ever came of it and my attempts at reaching out to her case worker resulted in unanswered messages) but I fear being shut out if I do. Emergency services advised me to contact the local magistrate but my dad has made that clear that would be against his wishes. An anonymous call will not work because they have become so reclusive they never see anyone but me and my immediate family. MIL hasn’t left the house even to go outside in three years.
I have tried talking to my dad many times that she needs help and that she is being manipulative and abusive to him and her mother to keep them from doing so. I’ve explained that if/when MILs mother passes he is going to need someone IMMEDIATELY to take over care for her. He insists he will deal with it when he has to. He’s in incredible denial.
My hope is that I can at least find resources that I can set up for him as he is unable and unwilling to get the ball rolling. It breaks my heart that there are three people with zero quality of life. Their days are revolving around keeping MIL appeased and MIL is in dire need of help.
Is this just a case of where I just need to let them live their lives they way they want to or is there something that can legally be done? What resources are there for them?
submitted by Substantial_Echo_906 to askatherapist [link] [comments]


2024.05.19 02:37 Killer_queef Is this crazy or is it just me?

I need opinions. I’ve been a nurse for 13 years, mainly ICU and PACU. After major burnout tried GI clinic, couldn’t do the sitting at a desk five days a week. Now I’m doing home health. Really liked it at first, liked moving around all day and meeting different patients, doing some actual hands-on care again. I signed on for 32 hour week so I could catch a break even though it’s a bit of a pay cut.
Fast forward to three months in. They took me off orientation like 4-5 weeks early due to two of the other RNs going on LOA (classic). They told me they’d give me a company car and no one’s answering me when I inquire about it (have tried twice now). I was told 1 weekday and 1 weekend on-call shift per month when I interviewed. I was put on call for the first time Mon/tues/wed this week (4p-8a the next day between my shifts) and am now on-call Sat and Sun (8am Sat-8am Mon). They’ve assigned me an admission visit each day (like 2 hour visit plus 2 hrs of documentation), two check in calls and a follow up visit. Then Monday I have a full patient load and start my new week. To me that’s not on-call, that’s weekend shifts.
Like wtf? So I’ll only have one day off in two weeks essentially. Not to mention, I signed up for 32 hours and have been working btwn 40-50.
Home health RNs, does this sound typical? Cause from everything I’ve heard most people love this job but this SUCKS.
Thanks in advance, RN in career crisis
submitted by Killer_queef to nursing [link] [comments]


2024.05.19 01:50 Interesting-Cup-3860 Labs question

Labs question
Would anyone with similar numbers mind giving me some insight? I know everyone is different! I know it could all mean nothing! lol just looking to see if anyone has ideas 🙂 30 year old female - randomly got shingles end of April, took valacyclovir and it’s all cleared up now. Was due for a med check for my zoloft and my yearly exam, mentioned to PCP about recent nausea (very odd symptom for me, only happened during pregnancy and when I had the stomach flu two years ago) but figured it could be from the shingles medication, having pain in upper right abdomen right under bra line and sometimes right above my hip bone, GI issues (not new for me, had colonoscopy 2018 came out all good, but same year did have my gallbladder removed because of stones)… PCP ordered bloodwork, abdominal ultrasound, and colonoscopy… ultrasound came back “very small amount of inflammation of liver but nothing of concern”, I’ll attach bloodwork results in a screenshot, and originally had my colonoscopy scheduled for July 8th but after getting my bloodwork back he called the GI to have it moved up and I’m currently waiting on a return call… I didn’t get a chance to talk to my doctor before the weekend to know what exactly he’s thinking is going on, all his nurse could tell me was “these are positive for something likely autoimmune” and I’m just wondering if anyone here might have an idea since you’re all pretty educated on these numbers! Thanks in advance!
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2024.05.19 01:43 KrystleOfQuartz Thyroid help! And basically just a vent sesh.

Hello friends. Im sitting here very tempted to pull out my Celluma panel and pop it on my thyroid, but Im feeling very nervous to do so.
I am 5 weeks pregnant again, after 3 consecutive miscarriages. The reason I bought the panel was for fertility reasons, so we shall see how its helped.....
But, I have been working with a Reproductive Immunologist for the last 6 months, prepping for a conception cycle and I have been loaded up with Prednisone and other meds... which have literally fucked my thyroid up beyond words, excuse my French.
The nurse practitioner has had me change my thyroid meds on a weekly basis [that's how often we check them]. My TSH is sitting high at 4.3 right now and my T4 is sitting higher at 2. Clearly this is NOT optimal for pregnancy. So today, the doctor herself tells me to double up on my thyroid meds, and now low and behold I have a freaking swollen thyroid - which has never happened to me before. Looks like a lump the size of a dime just grew in hours.
I am really hesitant to use the panel, but seeking anti-inflammatory options. Please note im taking Estradiol which raises your T4 too and TSH. [or so my doc says]. Should I just ditch the panel and let my body adjust or use it for a few minutes to see it if helps at all?
Really asking if anyone else has been in this rare situation?
submitted by KrystleOfQuartz to redlighttherapy [link] [comments]


2024.05.19 01:30 Imaginary_Sky_518 I’ve just hit 3mg on saxenda and not losing anymore. Should I Switch to mounjaro?

I’ve lost 9.2kg in 12 weeks on saxenda. Most of that was the first 6 weeks. I was on 1.2-1.8 most of my journey but then the food noise and hunger returned so I was moving up in half doses every week or two. I’d move up 5 clicks and then after a week or two on that dose the noise and snacking would return so then I’d move up again.
I’ve just hit 3mg. My appetite suppression is ok, snacking is under control. But my weight still isn’t moving.
I am on my second last saxenda pen. My doc has given me a script for sax and 5mg mounjaro and I’m trying to figure out whether to stick with sax or switch to MJ.
I’m just worried the same thing will happen with MJ and where I am the higher does are really exy. Like almost triple the cost of the highest dose of sax 😰
For reference, I have insulin resistance. I drink 2-3 L of water per day, I have high protein low carb medical meal replacement shakes x2 daily. Last meal is usually eggs, steak and salad or chicken veg. I have half a slice of sourdough and a snack of cheese and crackers each day. Lately I’ve been craving lollies and getting stuck into them. 😞 I usually get 10k steps in each day. I am working with a nurse practitioner, dietitian and weight loss doc. My doc said to stick with sax for as long as I’m losing and if that stops to switch to MJ. NP says switch to MJ as she thinks it’s more effective. I’m just really worried the same thing will happen on MJ and I’ll be struggling to buy it and not even losing on it anyway. 😔
Any advice or words of wisdom? Thanks so much!
submitted by Imaginary_Sky_518 to Mounjaro [link] [comments]


2024.05.19 01:30 barsaat Ideas needed for a relaxing extended solo trip. Please help me decide where to go!

I’m looking for specific suggestions about an extended solo trip - the purpose of the trip would be swimming, nature, art, food, cafes, beer or drinks in a relaxed atmosphere. For example a great time for me would be people watching in different cafes, going to the art gallery, sitting in a balcony looking at nature, snorkelling or short hiking 2 hour trips in nature by the water. I am recovering from an ankle injury and able to walk but want to spend longer in fewer locations and just relax, read and eat. Not really looking to party, I want peace and at most would sit at the bar and nurse 1-2 drinks if I am drinking. My preference is for quiet environments.
I’m an experienced traveller but this would be my first solo trip. I am confident with navigating language barriers and looking up things to do. I would like to avoid places where there is a lot of street harassment, I don’t want a lot of attention and would like to dress comfortably. I am queer presenting (hairstyle etc) and a person of colour, I would like to feel mostly safe e.g. Pakistan was not safe in this respect.
I would be travelling from Toronto, Canada in late July/August and can stay for as long as I want. Preferably would like to stay for 2 months.
I don’t drive, renting a car or motorbike is not an option so I would need public transportation to be safe and accessible.
Largest part of the budget would be long distance flights and accommodation. I have some savings I plan to put towards the trip and am usually good at budgeting but the accommodation cost is the main thing dictating the length of my trip.
I’m open to any suggestions, the more specific the better, e.g. choosing accommodation is my biggest barrier as there are so many options to choose from at varying prices. I would like a private room in a hostel / hotel / guest house or airbnb as I have insomnia.
Places I have been:
Vietnam
Thailand
Cambodia
Sri Lanka
Pakistan
Nepal
Japan
Malaysia
Turkey
Germany
Sweden
Italy
Amsterdam (Netherlands)
America
I am considering one (or more) of these options:
South Korea - this seems pricey, a quick google shows hotel prices being over $100/ a night in Seoul and I have heard it is harder to eat alone there? I haven’t been there and would like to go some day, and I love Korean food.
Going back to Japan - I loved it there, the hotels are not cheap but the food is cheap and excellent. I just went last May so it may be too soon to go back? Haha.
Going back to Thailand - again, I love the food, night markets were great
Going back to Vietnam - again, I love the food
Taiwan - I haven’t been there, I have heard that this is a good option as it is small and easy to walk or take buses to explore
Some kind of train or boat journeys?
Some kind of beachy quiet island vibes?
I considered all-inclusives but they seem geared towards couples or families with kids
Open to travelling within Canada instead of in SEA, but it would probably not be cheaper, and may end up being even more expensive with food and accommodation being expensive here, so it is not my first choice.
Thanks in advance
submitted by barsaat to femaletravels [link] [comments]


2024.05.19 01:11 Imaginary_Sky_518 I’ve just hit 3mg and not losing anymore. What do I do? Switch to mounjaro?

I’ve lost 9.2kg in 12 weeks on saxenda. Most of that was the first 6 weeks. I was on 1.2-1.8 most of my journey but then the food noise and hunger returned so I was moving up in half doses every week or two. I’d move up 5 clicks and then after a week or two on that dose the noise and snacking would return so then I’d move up again.
I’ve just hit 3mg. My appetite suppression is ok, snacking is under control. But my weight still isn’t moving.
If you’re on 3mg, how do you find it? Does the hunger return after a week or two? Did it stop being effective?
I am on my second last pen. My doc has given me a script for sax and mounjaro and I’m trying to figure out whether to stick with sax or switch to MJ.
I’m just worried the same thing will happen with MJ and where I am the higher does are really exy. Like almost triple the cost of the highest dose of sax 😰
For reference, I have insulin resistance. I drink 2-3 L of water per day, I have high protein low carb meal replacement shakes x2 daily. Last meal is usually eggs, steak and salad or chicken veg. I have half a slice of sourdough and a snack of cheese and crackers. Lately I’ve been craving lollies and getting stuck into them. 😞 I usually get 10k steps in each day. I am working with a nurse practitioner, dietitian and weight loss doc. My doc said to stick with sax for as long as I’m losing and if that stops to switch to MJ. NP says switch to MJ as she thinks it’s more effective. I’m just really worried the same thing will happen on MJ and I’ll be struggling to buy it and not even losing on it anyway. 😔
Any advice or words of wisdom? Thanks so much!
submitted by Imaginary_Sky_518 to liraglutide [link] [comments]


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