Statistic of munchausen syndrome

MunchausenSupport

2022.03.31 07:45 MmeOblivia MunchausenSupport

This is a support community for those who have experienced medical abuse or medical child abuse, including but not limited to abuse by caregivers who may have had Factitious Disorder Imposed upon Another, formerly known as Munchausen Syndrome by Proxy. At this time, those who have been indirectly affected by this type of abusive behavior are also welcome, as long as the focus remains on one’s own feelings and experiences, and is not about another person.
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2024.05.19 05:58 AdInteresting2401 Don't let that bougie doctor get you down mama bear!💪 "hEDS"

Experiences from the medical world regarding certain topics (these are not my comments):
.
"EDS is a genuine clinical entity. There are multiple subtypes with known mutations which will show up on a genetic panel.
There is a hypermobile subtype with no (known) genetic marker and relatively subjective diagnostic criteria. This makes it prime real estate for hpeful folks fishing for a diagnosis to explain their symptoms. In my experience it's generally self-diagnosed or diagnosed without investigation (eg by the very damaging PT run POTS/EDS clinic in town).
The hyoermobile subtype may have a pathological basis we simply don't yet understand and we shouldn't kmmediately dismiss it from a patients history. That said, it's been widely adopted in the Munchausen's by Internet communities and propagated by predatory borderline-alternative practitioners. I use it as a marker for a patient needing a more careful psychiatric history."
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"Great job for recognizing that EDS is comprised of 13 very distinct types that stand on their own. It sucks that most generalize EDS as one condition. There is a big difference between Vascular, Kyphoscoliotic, types, ect. and the hypermobility type. Its a bummer when a person with vEDS will not be taken serious because of a medical professional's experience and subsequent stigmatization that comes with a hEDS shit-show."
.
"To clarify, I’m speculating on a specific subset of patients I’ve seen with no family history of EDS. These patients rarely meet diagnostic criteria, have undergone extensive testing with no abnormality found, and yet the reported impact on their quality of life is devastating. Many are unable to work or exercise, are reliant on mobility aids, and require nutritional support. A co-worker recommended I download TikTok and take a look at the hashtags for these conditions. There also seems to be an uptick in symptomatic vascular compression syndromes requiring surgery. I’m fascinated."
submitted by AdInteresting2401 to MCAS_ [link] [comments]


2024.05.19 05:58 AdInteresting2401 Don't let that bougie doctor get you down mama bear!💪"MCAS"

Experiences from the medical world regarding certain topics (these are not my comments):
.
"-self-diagnosed, unconfirmed and typically incorrect - and unfortunately perpetuated by unsuspecting PCPs who trust their patients' reports and presume the diagnosis was confirmed (i.e., did not confirm as above). When the PCP refers to a specialist for management, that specialist says wut?, then then the patient ends up with me.
-Doctor shoppers. This is elevated to a fine art by some. I get referrals who have already been seen by the diagnostic clinics at half a dozen top tier US university diagnostic clinics already - I typically refuse these because I doubt I have anything to add, I have a 3 - 6 month-waiting list - not fair those with no workup yet.
-Many have psychiatric or behavioral or personality disorder component that plays in. Sometimes it's mild, especially in the form of secondary gain. Many lobby for a disability label to get out of working, but seem able to work.
-Some seem to have real psychiatric disease. These folks almost always refuse a psych referral.
-Full blown Munchausen Syndrome, or MS by Proxy, the latter of course is the ultimate can of worms for pediatrics."
.
"Of course food allergies, FPIES, EOS and mastocytosis are real. The problem is when parents live on forums, and get told "you need a better doctor"., and it's really diagnosis (x).
My allergist had a ton of self referrals until covid hit. Now the clinic plays hard ball on a full work up before you get an appointment. He got tired of parents on a mission, with a consult from Dr. Google."
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"Like Lyme disease, MCAS was hijacked by quacks.
Basically, the scheme involves:
The above applies to Lyme, gluten problems, MTHFR, vaccine injuries, heavy metal toxicity, bartonella, babesia, and other dubious diagnoses frequently sold by those who market themselves as functional, integrative, alternative, holistic, and naturopathic.
In a book excerpt, Dr. Jonathan Howard explains the psychology of fake diagnoses. Lists of non-specific symptoms are used so that the diagnoses can fit almost everyone.
Two of the top MCAS charlatans are business partners Lawrence Afrin, MD and Tania Dempsey, MD. Both advertise as "integrative" and have been associated with the dangerous pseudoscience group ILADS. Dempsey admits that she thinks 80+% of her "chronic Lyme" patients have evidence of MCAS.
See also:
submitted by AdInteresting2401 to MCAS_ [link] [comments]


2024.05.19 02:45 The_Brand94 RIGL Thesis 5/18/2024

~RIGL Thesis – 5/18/2024~
Outstanding Shares 175M
131 Institutional Holders
111,129,461 Total Shares Held
63.36% Institutional Ownership
Total Cash on Hand 3/31/2024 = $49.6M
Total Debt: $101.5M
Cash Burn Approximate = $8M per quarter (6 quarters of cash without any increases in revenue)
Q12023 REV = $26M
Q22023 REV = $26.8M
Q32023 REV = $28.1M
Q42023 REV = $35.8M
Q12024 REV = $29.5M (Decline from Q4 likely from end of year versus new-year tracking of Rx and shipments of drugs, resetting of Copays)
Most Recent EPS -$0.05 per share
May 22, 2024 - Vote on S will take place, caution
~Statistics Applicable To Thesis~
333.3 million US Population (2022)
8,109,679,892 Global Population (2024)
~Drugs On Market~
~Tavalisse – Treatment for ITP, FDA Approved April 17, 2018~
~What is ITP?~
Immune thrombocytopenia (ITP) is an illness that can lead to bruising and bleeding. Low levels of the cells that help blood clot, also known as platelets, most often cause the bleeding.
Once known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises. It also can cause tiny reddish-purple dots on the skin that look like a rash.
Children can get ITP after a virus. They most often get better without treatment. In adults, the illness often lasts months or years. People with ITP who aren't bleeding and whose platelet count isn't too low might not need treatment. For worse symptoms, treatment might include medicines to raise platelet count or surgery to remove the spleen. Immune thrombocytopenia (ITP) - Symptoms and causes - Mayo Clinic
~What is Tavalisse?~
TAVALISSE is a prescription medication used to treat adults with low platelet counts due to chronic immune thrombocytopenia (ITP) when a prior treatment for ITP has not worked well enough. It is not known if TAVALISSE is safe and effective in children.
The cost for Tavalisse oral tablet 100 mg is around $15,404 for a supply of 60 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Tavalisse Prices, Coupons, Copay & Patient Assistance - Drugs.com
TAVALISSE IS AN ORAL MEDICATION TAKEN TWICE DAILY WITH OR WITHOUT FOOD1
A 12-week evaluation period is recommended
60 tablets = 1 month supply, evaluation period = 3 months, Cost for 3 months = $46,212 Cash, assuming cheaper through wholesale, insurance, discount cards, etc.
Dosing TAVALISSE® (fostamatinib disodium hexahydrate) tablets (tavalissehcp.com)
~Addressable Market~
“Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.”
Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis - PubMed (nih.gov)
The estimated prevalence of ITP in the United States is 9.5 per 100,000 people, with a global prevalence of over 200,000 people at any given time [1].
Immune thrombocytopenia. [ Oct; 2022 ]. 2022. https://rarediseases.org/rare-diseases/immune-thrombocytopenia
~Author Calculations/Estimates~
ITP estimated cases based on measured statistics 31,635 cases a year in the US and 770,355 cases globally each year.
~Rezlidhia – R Acute Myeloid Leukemia, FDA Approved December, 22, 2022~
~What is Relapsed or Refractory Acute Myeloid Leukemia?~
Relapsed, or recurrent, acute myeloid leukemia (AML) means the leukemia has come back after treatment and remission.
Refractory AML means the leukemia did not respond to treatment. Complete remission has not been reached because the chemotherapy drugs did not kill enough leukemia cells.
Both relapsed and refractory AML need more treatment to reach complete remission.
Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Some factors considered for your treatment include:
your age
your health
how long the leukemia was in remission
treatments you had before
where the leukemia comes back
Treatment options usually include chemotherapy and a stem cell transplant if possible. Targeted therapy may also be used.
Treatments for relapsed or refractory acute myeloid leukemia Canadian Cancer Society
~What is IDH1?~
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult Acute myeloid leukemia (AML) and less commonly in pediatric AML… Enhanced genomic and epigenomic profiling of acute myeloid leukemia (AML) has led to identification of recurrent mutations that are prognostic and are candidates for targeted therapy. Somatic mutations in isocitrate dehydrogenase (IDH) genes, IDH1 and IDH2, occur in ∼6% to 16% and ∼8% to 19% of adult patients with AML, respectively.1-5 In pediatric AML, IDH mutations are rare, occurring in <4% of patients.6-11
Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis Blood Advances American Society of Hematology (ashpublications.org)
~What is Rezlidhia?~
REZLIDHIA is a prescription medicine used to treat adults with acute myeloid leukemia (AML) with an isocitrate dehydrogenase-1 (IDH1) mutation when the disease has come back or has not improved after previous treatment(s).
Targeted Treatment REZLIDHIA® (olutasidenib) capsules
The cost for Rezlidhia oral capsule 150 mg is around $17,468 for a supply of 30 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Rezlidhia Prices, Coupons, Copay & Patient Assistance - Drugs.com%20is%20a%20member,on%20the%20pharmacy%20you%20visit.)
~Addressable Market~
The annual incidence of new cases in both men and women is approximately 4.3 per 100,000 population, totaling over 20,000 cases per year in the United States alone.[13] The median age at the time of diagnosis is about 68, with a higher prevalence observed among non-Hispanic Whites. Furthermore, males exhibit a higher incidence compared to females, with a ratio of 5:3.
Acute Myeloid Leukemia - StatPearls - NCBI Bookshelf (nih.gov)
~Author Calculations/Estimates~
Cases of AML with IDH1 would be 11% based on the median of statistics above (6% to 16%) leaving approximately 1500 to 2000 cases a year in the US. Appling the same calculations to world population would amount to approximately 38,500 cases a year globally.
~Gavreto – Treats RET+ Non-Small Cell Lung Cancer In Adults and RET+ Thyroid Cancer in Kids and Adults, FDA Approved August 9, 2023~
For the sake of common ground, I am going to assume these types of cancers do not need to be elaborated on as we all likely have a basic understanding of what they are. The medical conditions treated by Tavalisse and Rezlidhia I felt needed a more in-depth explanation because they are not common. I will elaborate on RET+ a little later in this writing.
~What is Gavreto?~
GAVRETO is an oral once daily prescription medicine used to treat certain cancers caused by abnormal rearranged during transfection ~(RET+)~ genes in:
Adults with non-small cell lung cancer (NSCLC) that has spread
Adults and children 12 years of age and older with advanced thyroid cancer or thyroid cancer that has spread who require a medicine by mouth or injection (systemic therapy) and who have received radioactive iodine and it did not work or is no longer working*
It is not known if GAVRETO is safe and effective when used to treat cancers caused by abnormal RET genes in children for the treatment of NSCLC or in children younger than 12 years of age for the treatment of thyroid cancer.
Home GAVRETO® (pralsetinib)
The cost for Gavreto oral capsule 100 mg is around $11,745 for a supply of 60 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
The recommended dosage for adults and children 12 and over is 400mg orally once daily. Each capsule is 100mg, which means you will take 4 capsules. Gavreto should be taken on an empty stomach, at least 1 hour before or 2 hours after a meal.
Gavreto Prices, Coupons, Copay & Patient Assistance - Drugs.com
~What is Rearranged During Transfection Positive (RET+)?~
RET-positive cancer is caused by a mutation or abnormal re-arrangement of the RET gene. It occurs most commonly in lung cancer and several types of inherited and sporadic thyroid cancers. RET alterations also occur in an estimated 1-2% of multiple other cancers, including ovarian, pancreatic, salivary, breast, and colorectal cancers.
RETpositive Empowering Patients and Driving Research
Rearranged during transfection (RET) rearrangements were first identified as oncogenic drivers in NSCLC in 2012. The proportion of patients with NSCLC who have RET rearrangements (ie, fusion-positive disease) is approximately 1%-2%.
RET Fusion-Positive Non-small Cell Lung Cancer: The Evolving Treatment Landscape The Oncologist Oxford Academic (oup.com)
RET alterations occur most commonly in lung cancer (non-small cell lung cancer (NSCLC)) and the number of new cases diagnosed each year is considerable, accounting for approximately 37,500 [IG1] cases worldwide and 4,000 cases in the US (2% of NSCLC) (2,3). RET alterations are also common in several types of inherited and sporadic thyroid cancers and can occur in other types of cancers like ovarian, breast, pancreatic, and colorectal cancers, among others (4-8) adding >110,000 cases yearly worldwide (9).
What is RET Positive Lung Cancer? - The Happy Lungs Project
(2) Although medullary thyroid carcinoma represents 5-10% of all thyroid cancers, activating RET gene abnormalities occur in over 90% of hereditary and approximately 40%-60% of sporadic medullary thyroid carcinoma cases.
Patients – RETpositive%20Although%20medullary%20thyroid%20carcinoma,sporadic%20medullary%20thyroid%20carcinoma%20cases.)
~Prevalence of Non-Small Cell Lung Cancer~
Most lung cancer statistics include both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). In general, about 10% to 15% of all lung cancers are SCLC, and about 80% to 85% are NSCLC.
Lung cancer (both small cell and non-small cell) is the second most common cancer in both men and women in the United States (not counting skin cancer). In men, prostate cancer is more common, while breast cancer is more common in women.
The American Cancer Society’s estimates for lung cancer in the US for 2024 are:
About 234,580 new cases of lung cancer (116,310 in men and 118,270 in women)
About 125,070 deaths from lung cancer (65,790 in men and 59,280 in women)
Lung Cancer Statistics How Common is Lung Cancer? American Cancer Society
Worldwide, an estimated 2,206,771 people were diagnosed with lung cancer in 2020. These statistics include both small cell lung cancer and NSCLC.
Lung Cancer - Non-Small Cell: Statistics Cancer.Net
~Author Calculations/Estimates~
Approximately 187,664 cases of NSCLC in the US based on an 80% factor.
Approximately 1,765,416 cases of NSCLC worldwide based on an 80% factor.
~Prevalence of Thyroid Cancer~
Rate of New Cases and Deaths per 100,000: The rate of new cases of thyroid cancer was 13.5 per 100,000 men and women per year. The death rate was 0.5 per 100,000 men and women per year. These rates are age-adjusted and based on 2017–2021 cases and 2018–2022 deaths.
Lifetime Risk of Developing Cancer: Approximately 1.2 percent of men and women will be diagnosed with thyroid cancer at some point during their lifetime, based on 2017–2019 data. Lifetime risk based on data through 2022 will available soon.
Prevalence of This Cancer: In 2021, there were an estimated 979,295 people living with thyroid cancer in the United States.
Thyroid Cancer — Cancer Stat Facts
About 44,020 new cases of thyroid cancer (12,500 in men and 31,520 in women)
About 2,170 deaths from thyroid cancer (990 in men and 1,180 in women)
Thyroid cancer is often diagnosed at a younger age than most other adult cancers. The average age when a person is diagnosed with thyroid cancer is 51.
This cancer is about 3 times more common in women than in men. It is about 40% to 50% less common in Black people than in any other racial or ethnic group.
Key Statistics for Thyroid Cancer American Cancer Society)
Addressable Market
Given Gavreto’s dual treatment capacity, the total amount of potential patients with NSCLC with RET+ indications would be approximately 2,800 cases in the US and approximately 26,500 cases worldwide each year using a factor of 1.5% of total NSCLC cases. The total amount of treatable cases for Thyroid Cancer would be approximately 650 in the US and 16,500 cases worldwide respectively each year applying the same 1.5% RET+ percentage rate. DOUBLE CHECK MATH…
~Rigel Pharmaceuticals Pipeline~
~IRAK/4 – Clinical Trials~
Rigel’s investigational candidate, R289, is an oral, potent and selective inhibitor of interleukin receptor-associated kinases 1 and 4 (IRAK1/4).
Toll like receptors (TLRs) and the interleukin 1 receptor family (IL-1Rs) play a critical role in the innate immune response and dysregulation of these pathways can lead to a variety of inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease. Chronic stimulation of both receptor systems has also been implicated in causing a pro-inflammatory bone marrow environment leading to persistent cytopenias in lower-risk myelodysplastic syndrome (LR-MDS) patients1.
R835 is a selective dual inhibitor of IRAK1/4 that blocks TLR4 and IL-1R-dependent systemic cytokine release. In preclinical studies, R835 demonstrated activity in multiple animal models of inflammatory disease2,3 and showed that dual inhibition of IRAK1 and IRAK4 provided more complete suppression of inflammatory cytokines when compared to an IRAK4-selective inhibitor4.
Development of R289:
In a Phase 1 clinical trial, R835 was well tolerated and inhibited LPS-induced inflammatory cytokine production in healthy volunteers, demonstrating proof-of-mechanism.5 Phase 1 clinical studies of R289 (an oral prodrug that is rapidly converted to R835 in the gut) are also complete.
A Phase 1b open-label, multicenter trial of R289 in patients with relapsed/refractory lower-risk MDS is currently enrolling (NCT05308264). The primary endpoint for this trial is safety with key secondary endpoints including preliminary efficacy and evaluation of pharmacokinetic properties.
~Bemcentinib – Bergenbio Partnership~
In June 2011, Rigel entered into an exclusive, worldwide research, development and commercialization agreement with BerGenBio for its investigational AXL receptor tyrosine kinase (AXL) inhibitor, R428 (now referred to as bemcentinib).
Bemcentinib is a potent, selective and orally bioavailable AXL inhibitor and the furthest along in clinical trials. In preclinical studies, bemcentinib was shown to have an effect as a single agent therapeutic in the prevention and reversal of acquired resistance to standard of care cytotoxics and targeted therapies and may also slow or prevent tumor metastasis.
Rigel received an upfront payment and is eligible for milestone payments and potential sublicensing revenue, as well as tiered royalty payments on any future net sales of products emerging from the collaboration.
~R552 Systemic – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies.
~Milademetan – Daiichi Sankyo Partnership~
Rigel has a long-standing collaboration with Daiichi-Sankyo for developing murine double minute 2 (MDM2) protein inhibitors in cancer, which were discovered in Rigel’s laboratories.
Preliminary safety and efficacy data from an early Phase 1 study of milademetan (formerly DS-3032), an oral selective MDM2 inhibitor, in hematological malignancies suggests that it may be a promising potential treatment for oncology indications.
Rigel received an upfront payment and is eligible for milestone payments, as well as tiered royalty payments on any future net sales of any products emerging from the collaboration.
~Rxxx (CNS Penetrant) – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies. Pipeline :: Rigel Pharmaceuticals, Inc. (RIGL)
~Summary and Prediction~
The current share price of sub $1 does not feel justified. I would anticipate financial breakeven by the end of 2024 or potentially in Q1 or Q2 of 2025. The robust pipeline, progress, and expected revenue growth are enough to justify a much higher valuation. The debt load is manageable, but the potential for S is concerning. I believe that the S is not necessary and revenue growth and progress should speak for itself. I am not as bullish as the analysts at HC Wainright for a $15 PT, but the valuation should be at least 3x to 5x from the current value. This thesis does not highlight the patents surrounding their drugs either which some extend into 2035 and beyond. Perhaps what Wall Street is discounting is the fact that most of the drugs are very niche. However, the currently available drugs have an addressable market, albeit less universal than some, but you should value it in the sense of multiple facets (a 1000 headed snake is the phrase I wanted to use). I believe the company should be valued with specialty drugs in mind which would command a higher PE ratio. At the current day and time of writing, the value should be at least $1.50 to $1.75 ~at a minimum~ with a 12 month price target of $3 to $5+. I will be looking for continued revenue growth in each quarter this year and realization of revenue from Gavreto in Q2 or Q3 this year. The partnerships should not be discounted either and the current share price if it lingers here perhaps may attract a merger or acquisition. I initially began the research thinking that perhaps the drugs were too niche, but given the multiple drugs they are working with, I believe their revenue sources will continue to grow if you do not focus on one particular drug as the main performer. With the most recent inflation report being cooler than expected, I would suspect larger funds and institutions will be circling back to riskier assets.
submitted by The_Brand94 to u/The_Brand94 [link] [comments]


2024.05.19 01:57 BigSnekEnergy My boyfriend is out of my league

I (31 FTM) have been with my boyfriend (27FTM) since summer 2022. I frequently worry I’m not mature enough for him because he’s much further along in life even though he’s a great deal younger than me.
I’ve accomplished basically nothing with my life though it’s not for lack of trying. I got a really late start on life due to a combination of extreme abuse and Munchausen syndrome by proxy. My mom greatly exaggerated a mild learning disability diagnosis I got when I was a teenager and made it sound like I had a profound intellectual disability. She maintained total legal and financial control over me up until fairly recently and kept me very isolated with no cell phone and virtually no internet access. I didn’t fully get away until about a year ago and started my journey towards independence in 2019.
I’ve made progress but not much. I have a job, a drivers license and an associates degree. I’m thinking of coming back from my bachelors. However, I only have one job because I’m also busy with college stuff and no car because I unfortunately don’t have enough money saved up yet to buy one.
I also unfortunately still live with roommates because with the place I live in you can’t get even a studio apartment for less than 2K a month. The only reason my boyfriend has his own places because he works three jobs and his parents chip in on his rent. The one equalizing factor between us is that neither of us makes six figures but still. For him that’s entirely appropriate. For me, there’s no excuse.
I feel like he’s a more of a real adult than I am. I had to ask him how to do things like file taxes, because I had never been allowed to do anything like that before. He also has a full bachelors degree and a car. Given, it’s his dad’s old car and his parents paid his tuition in full Meanwhile, I have to pay mine entirely single-handedly but still.
Considering the state that the economy’s in my boyfriend is at an appropriate place to be at in life for his age. Meanwhile, I am old and I am at the life stage of an 18 year old. Maybe even less than that since most people have their own cars by 18. I don’t know if I’ll ever catch up, and I often worry about being a burden to him or that he’s out of my league.
Because I was so isolated and heavily controlled until I got out there were a lot of things I didn’t know in the beginning. Most of it I picked up on my own, but some of it I had to ask about. I usually pick things up pretty quickly and don’t need help from there on out but it’s embarrassing that I have to ask for explanation at all.
It feels like I am really behind in life And can never catch up. I also worry about coming off as a man child, and being a burden on him. Sometimes I wonder if I should stay away from relationships all together because my background makes me a walking red flag.
submitted by BigSnekEnergy to datingadvice [link] [comments]


2024.05.18 22:03 Silver_Atmosphere546 Just ranting...

Hi everyone, I'm new . I'm just venting as I want to get this off my chest. I'm late 30s, no kids and don't want any. Low NC with my mom, barely speak to my dad.
My mom called the other day in regards to finding out my dad was in the hospital for a week. He is not of sound mind as he was telling my mom he was at some hospital in Cali, but he's actually in Arizona.
She said he was out in the desert testing his car. From what he's telling us, whatever happened out there doesn't make sense. So, he was tested for dementia and he doesn't have it but he needs another opinion. Doc said it's a simple forgetfulness.
His friend told me my dad was driving to the mvd and he knew where it was but he never stopped. He drove for 3 hrs without realizing at all he went too far and still insisted he was 5 minutes away from the mvd. That's not a simple forgetfulness.
Mom is 77 and dad is 78. He even got his own age wrong, he said he's 81. He's not of sound mind, he's repeating the same things, etc
So, my mom was telling me this via phone. This is how she is, she said I don't know what to do. Her typical answers for life. This is someone who doesn't read, has no computer and phone skills to look things up, has 0 knowledge on life in general
She's the type to do everything at the last minute in a panick. I said the time is now to get things in order in case he does something and kills himself. She has no access on him because he doesn't allow my mom to know anything but his Mistress has access. I don't see how legally
She has no assets in her name (never worked), gets SS and an allowance from my dad. As the spouse (who knows if she is legally), she's doing absolutely nothing in regards to researching her options etc.
My brother whos in another state is aware of whats going on. This crap has pissed me off to a T. I told her I'm not using FMLA to do anything as that's taking way too much time away from.my job
She doesn't plan for anything in advance. She always says yea I'll look into it never does and asks us the same stupid questions over and over
What passed me off more during the conversation was how she did her best, staying married to him was better and how her "children " weren't statistics. She started the process of her divorce when I was 11 but gave dad more chances.
Then she told me how she left behind her 1st born (1st born daughter is not my dad's kid) because she wasn't ready to be a mom. What?! That's a new one as she has never said that before.
During that part of the conversation, all I heard were the typical excuses, my God the amount of lies, and still standing beside an abuser, misogynist, pedophile and cheating husband like congratulations. I was done, I got off the phone (I was at work).
Is that what I'm supposed to be greatful for? I wish I could see my therapist right now. I'm like what in the Stockholm syndrome am I hearing?!
I was surprised when I heard he was in the hospital and not of sound mind. He's been released buy he wants to go back to Cali in his condition.
My bf said you're gonna have to cut off your mom soon she's expecting you or your brother to do everything. My brother is POA on mom, because if dad dies unexpectedly, she is royally ******.
I already know this will be a yelling match with the golden child brother...
submitted by Silver_Atmosphere546 to raisedbynarcissists [link] [comments]


2024.05.18 01:13 Quiet_Reputation Multiple unrelated birth defects

Did anyone else tfmr for multiple issues? My daughter had three unrelated issues. Two birth defects and a genetic mutation. None run in our families and we’re not carriers. The odds of her having all three is 1/30 billion. My doctor said that is statistically impossible and that they are likely related in a way that we don’t understand, but there is nothing to relate them - no known syndrome or examples of others who have any of these things together. What went wrong? Was it just a “bad egg”? Is that even a thing?
I did have covid and pneumonia when she was conceived. The day after we “did the deed” I had three chest X-rays and started on paxlovid. Could that have caused this? I guess I’ll never know for sure, but it just seems like a big coincidence.
Is anyone in a similar position? I just don’t know how to move on after this and all of the unknowns.
submitted by Quiet_Reputation to tfmr_support [link] [comments]


2024.05.17 14:24 Tootsie_r0lla Munchausen by Internet: Current Research and Future Directions (mod approved)

Munchausen by Internet: Current Research and Future Directions
This is a really good study/ paper that i thought you guys may enjoy or find interesting. I recommend at least have a scroll through (it's not too long) but it's fairly digestible. Or copy the paragraphs and chuck em in chat gpt. If you don't have that then try Goblin Tools and select 'easier to read' or 'waffle less'. It really gets in to how Munchausens has/ is developing and how MBI may have to be included in the DSM. It includes what to look for, how to de-escalate, what to avoid etc
Factitious Disorder and Munchausens Factitious Disorder and Munchausen Syndrome Factitious disorder (FD) is an umbrella category covering a group of mental disturbances in which patients intentionally feign physical or mental illness without obvious benefit.
Here's a chat gpt summary of the paper:
Objective Munchausen by Internet occurs when medically well individuals fake recognized illnesses in virtual environments, such as online support groups. This paper focuses on the aspect of Munchausen by Internet in which individuals actively seek to disrupt groups for their own satisfaction, which has not yet been associated with the wider phenomena of Internet trolls (users who post with the intention of annoying someone or disrupting an online environment)
Results The limited research relating to motivation, opportunity, detection, effects, and consequences of Munchausen by Internet is highlighted and it is formally linked to aspects of trolling. Case studies are used to illustrate the phenomenon. What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims.
Conclusions We suggest ways to deal with Munchausen by Internet and provide advice for health group facilitators. We also propose that Munchausen by Internet and Munchausen by Internet trolling should be formally acknowledged in a revised version of the Diagnostic and Statistical Manual DSM-5. This will assist in effectively identifying and minimizing the growth of this behavior as more people seek reassurance and support about their health in the online environment. We also suggest directions for future research.
Please comment down below what your thoughts are on it
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2024.05.16 00:23 Ok-Description-6399 Guide-approach for complementary ketogenic regime and understand more

Complete remission of depression and anxiety using a ketogenic diet: case series

Front. Nutr., 14 May 2024 Sec. Clinical Nutrition Volume 11 - 2024 https://doi.org/10.3389/fnut.2024.1396685
Background: There is little data that describe the use of ketogenic metabolic therapy to achieve full remission of major depression and generalized anxiety disorder in clinical practice. We present a retrospective case series of three adults with major depression and generalized anxiety disorder with complex comorbidity, treated with personalized ketogenic metabolic therapy, who achieved complete remission of major depression and generalized anxiety disorder and improvements in flourishing, self-compassion, and metabolic health.
Methods: Three adults, ages 32–36, with major depression, generalized anxiety, other anxiety disorders, and comorbid psychiatric conditions were treated for 12–16 weeks with personalized whole food animal-based ketogenic metabolic therapy (1.5:1 ratio) in a specialized metabolic psychiatry practice. Interventions included twice-weekly visits with an experienced ketogenic registered dietitian; daily photo journaling and capillary blood BHB/glucose/GKI monitoring; virtual groups; family/friends support; nature walks and talks several times per week, and community building. Successful adoption of the ketogenic diet was defined as the achievement and maintenance of capillary BHB ≥ 0.8 mmol/L and GKI < 6. Remission was assessed by GAD-7 and PHQ-9, and quality of life was assessed subjectively and with validated scales for flourishing and self-compassion. Metabolic health was assessed by laboratories/biometric measures.
Results: Two patients achieved remission of major depression (PHQ-9 ≤ 4) and generalized anxiety (GAD-7 ≤ 4) within 7 weeks of therapeutic nutritional ketosis; one required 12 weeks. Anxiety responded and remitted more quickly than major depression. Flourishing and self-compassion increased steadily. Patients lost 10.9 to 14.8% of their initial body weight within 12 weeks and improved metabolically; one achieved optimal metabolic health.
Conclusion: Complete remission of major depression and generalized anxiety disorder occurred within 7–12 weeks of therapeutic nutritional ketosis during treatment with a personalized animal-based ketogenic diet (ratio 1.5:1) in adults with complex comorbid depression and anxiety engaged in a specialized metabolic psychiatry program.

Introduction

Emerging brain-based research in psychiatry and neurology has focused on identifying fundamental metabolic disturbances within neurons and throughout the body involving insulin resistance, inflammation, oxidative stress, and alterations of the gut microbiome (1). All four of these fundamental metabolic disturbances are present in major depression (2), and underlying anxiety disorders (3) and can be directly modulated through the use of ketogenic metabolic therapy (KMT) (4).
As psychiatric disorders have risen over the past several decades, the prevalence of metabolic syndrome has sharply increased, with only 12.2% of U.S. adults meeting the criteria for optimal metabolic health, leaving 87.8% metabolically compromised (5, 6).
Metabolic syndrome affects almost a third of individuals with major depression (7). It is a significant contributor to their morbidity and mortality (8) and is rooted in impaired glucose metabolism and utilization. Insulin resistance has been well described in many tissues, including the brain (9), where it is being investigated as a link between metabolic health and mental health conditions. Preclinical models demonstrate that glucose intolerance is directly associated with anxiety and that insulin resistance triggers depressive behaviors (9). In brain tissue, insulin resistance results in cerebral glucose hypometabolism and a vicious cycle of unmet energy needs (10). In human studies, cerebral glucose hypometabolism is a feature of major depression (11, 12) and generalized anxiety disorder (GAD) (13).
KMT, also known as the therapeutic ketogenic diet, or KD, is a low carbohydrate, moderate-protein, high-fat diet that supports a fundamental metabolic shift from glucose to ketone bodies as the primary fuel source (14). Classic KMTs are formulated with strict macronutrient ratios, most commonly 4:1 and 3:1 (fat: protein + carbohydrates), and have demonstrated efficacy in intractable epilepsy and genetic disorders. More recently, modified classic KMTs with lower macronutrient ratios of 2.5:1, 2:1, and 1.5:1 have been utilized in research and clinical practice (15, 16). These allow more variety in the diet, meet micronutrient needs except vitamin D (17), and are easier to sustain for extended periods of time.
KMT exploits the body’s natural ability to produce ketone bodies (d-beta-hydroxybutyrate (BHB), acetoacetate, and acetone) in the liver from fatty acids by keeping carbohydrate consumption very low. Acute and sustained production of ketone bodies produces a fundamental shift in fuel energetics within cells, particularly neurons, which can radically re-route and quickly rely on readily available BHB and acetoacetate for cellular energy (18). Ketone bodies also increase vascular density at the blood–brain barrier, which can strikingly increase the availability of ketone bodies for brain energy metabolism by 40-fold (19). Ketones are a preferred energy source in the CNS (20) and neurons will choose ketones over glucose when available.
Nutritional ketosis (10) using a KMT is a natural, not pathological, state (21) where the body’s energy and protein synthesis needs are met with a high-fat/moderate-protein/low-carbohydrate diet, resulting in sustained elevations of serum ketones and fatty acids and normal glucose without acidemia. In both acute and long-term nutritional ketosis, ketone bodies have a number of biological effects that directly change the brain’s cellular energy status (15), increase mitochondrial density (22), and improve mitochondrial morphology, which has been shown to be altered in mood disorders (23, 24). Mitochondrial abnormalities have also been postulated to be responsible for changes in synaptic function and neuroplasticity, potentially associated with symptoms of depression and anxiety (19).
Recent research shows that a ketogenic diet (KD) reduces neuronal firing rates, modulates ion channels and cell signaling cascades, and stimulates the biochemical synthesis and neurotransmission of GABA by inhibiting glutamate decarboxylase, a major inhibitory neurotransmitter involved in neuronal firing and anxiogenesis (25, 26). BHB activates the transcription of antioxidant-related genes by inhibiting histone deacetylases, triggering long-term adaptive changes in gene expression. In addition, at physiologic concentrations, ketone bodies reduce neuroinflammation through direct action at G-protein coupled receptors (25). KD also favorably alters the gut microbiome (27). Perhaps most importantly, KD directly increases NAD+, which reduces reactive oxygen species and increases mitochondrial ATP production. It is also utilized as a substrate for sirtuins and PARP enzymes associated with DNA repair and longevity. A sustained increase in NAD+ may underlie the pleiomorphic benefits of KMT across multiple neuropsychiatric conditions (28). In terms of the frequent abnormal alarms set off in the amygdala during anxiety, nutritional ketosis may provide an acute and long-term intervention to reduce generalized anxiety, panic attacks, obsessive doubt, and symptoms of post-traumatic stress disorder (PTSD). For apathy, anhedonia, amotivation, and abulia seen in major depression, therapeutic nutritional ketosis may provide higher and more sustained intraneuronal energy and repair (29, 30).
There is no published data that describes the implementation and use of personalized KMT for adults in real-world clinical practice who present with major depression comorbid with GAD and complex psychiatric comorbidity.
The aim of this case series is to examine the response to the treatment of major depression and generalized anxiety with whole-food animal-based personalized KMT in adults with complex psychiatric comorbidity and varied metabolic status. We conducted a retrospective review of three cases from our Metabolic Psychiatry Registry that demonstrate a consistent response and remission of major depression and generalized anxiety among patients who are psychiatrically and metabolically complex, despite differences in the initiation and adoption of KMT, and varied metabolic dysfunction. We describe the evaluation process and prescription of KMT, baseline metabolic workup and monitoring, elements that fostered treatment engagement and adherence, and challenges encountered during 12 weeks of KMT. We correlated capillary BHB/GKI with time to the remission of major depression and GAD and the achievement of metabolic health.

Discussion

Although KD was first shown to produce antidepressant effects and alleviate “behavioral despair” in preclinical studies more than 20 years ago (20), there is little clinical data regarding KD in major depression and anxiety disorders.
A retrospective analysis of 31 individuals with primary diagnoses of major depression (N = 7), bipolar II disorder (N = 13), and schizoaffective disorder (N = 12) who had failed to respond to conventional psychiatric care was treated with KD (75%–80% fat, 15%–20% protein, 5% carbohydrate) for 12 weeks in a psychiatric hospital (31). Of these patients, 22 were voluntarily admitted for the initiation of KD, and the remainder were offered KD during their inpatient hospital course. Change in depression was measured by HAM-D and MADRS in 6 of 7 patients with major depression and 12 of 13 patients with bipolar disorder. Notably, 100% of patients given the HAM-D showed statistically significant improvement in depressive symptoms (mean HAM-D decreased from 25.4 to 7.7; mean MADRS decreased from 29.6 to 10.1). However, serum ketones were not measured; urinary ketone measures were obtained once in 28 patients during the 12-week intervention; 18 patients (64%) showed positive urine ketones (31).
Bipolar depression was included in a recent randomized controlled pilot study assessing the safety and feasibility of KMT as adjunctive therapy, and reported safety and feasibility with excellent adherence and maintenance of ketosis (mean BHB 0.88 ± 0.99 mmol/L for 12 weeks) (32).
One case report utilized KD (65% fat, 25% protein, 10% carbs) with a time-restricted feeding window in a 65-year-old woman with major depression and type II diabetes and reported remission of depression (PHQ-9 17 to 0), normalization of HbA1c, decrease in estimated average glucose from 216 to 96 mg/dL, improvement in HOMA-IR from 9.4 to 2.3, and TG/HDL ratio from 4.7 to 1.2 over 12 weeks. The only measured serum BHB reported in the case was a mean of 1.5 mmol/L by week 12 (30).
A recent meta-analysis of low carbohydrate diets used in controlled trials that evaluated symptoms of depression and anxiety, not disorders, in varied metabolic and inflammatory conditions reported that the symptomatic response of these symptoms was inconclusive (33). The conclusions may not apply to KMTs; the meta-analysis was limited by grouping varied diets with higher carb intake and higher protein intake than usually associated with diets formulated to induce nutritional ketosis; serum or capillary BHB was not reported; and primary and secondary outcomes varied across studies.
In anxiety, preclinical research shows that exogenous ketone supplementation reduces anxiety behaviors (34). There is one case report of a self-administered Atkins Diet for weight loss in a woman with panic disorder (35) but no reports of KMT in panic disorder, OCD, or PTSD. Case reports of KD addressing anxiety describe two cases of decreased anxiety symptoms in a woman with women, one with bipolar I disorder and another with unspecified mood disorder, comorbid emotional dysregulation, body dysmorphic disorder, and eating disorder (36, 37), and one case report that describes the elimination of anxiety symptoms in a man with bipolar disorder (38). Anxiety and obsessive preoccupations improved in weight-restored anorexic women, in one case report describing complete remission of anorexia (39) and in a retrospective case series where animal-based KD was adopted without dietary prescription and monitoring (2); however, ketone measures were not reported. One small pilot trial where KD was followed by ketamine infusions reported a significant lessening of obsessive preoccupations in weight-recovered women with chronic anorexia; here, ketosis was measured by breath acetone (40).
Finally, all three patients had comorbid ADHD, which may be important. Approximately 65–89% of adults with ADHD experience one or more comorbid psychiatric conditions, and ADHD often occurs comorbid with anxiety and depression (41). Preclinical studies in murine models (42) of ADHD with hyperactivity suggest that KD may improve symptoms via alteration of the gut microbiome. Preclinical studies in dogs with epilepsy displaying ADHD-like behaviors treated with a medium-chain triglyceride KD have shown decreased pathological behaviors (43). Further research exploring the effect of KMT in humans with ADHD should be considered to understand the mechanisms of action and assess short- and long-term risks and benefits.
There is little research regarding the selection, implementation, and treatment course for KMT use as adjunctive or sole treatment in individual psychiatric conditions. Given the potential benefits of therapeutic nutritional ketosis and the restoration of metabolic health (44), there is a pressing need to identify the biological underpinnings of KD in psychiatric disorders and delineate factors associated with the successful adoption and adherence of KMT and responses in common psychiatric disorders such as depression and anxiety. In clinical practice and real-world settings, where patients often present with multiple comorbidities, consideration of KD can seem daunting to clinicians.
Despite that, this case series illustrates complete remission of both major depression and GAD in three adults with complex psychiatric comorbidity and previously unrecognized metabolic dysfunction using whole-food, animal-based personalized KMT. Anxiety responded first and time to remission occurred rapidly within 7–12 weeks, despite varied challenges, including preferences for time-restricted eating, slow adoption, inconsistent monitoring, and emergent fatigue during strenuous exercise, which occurred many weeks into KMT due to low serum carnitine and spontaneous reduction of protein intake rather than keto-adaptation or “keto-flu.” All patients improved metabolically, and one patient achieved optimal metabolic health (6).
These patients were representative of many adults in clinical psychiatric practice who present with persistent, serious symptoms interfering with several life domains. They each had five DSM-V psychiatric disorders: severe unipolar major depression, GAD, at least one other anxiety disorder (OCD, PTSD, and/or panic disorder), and ADHD, and two had binge eating disorder. They had all failed at least two previous adequate trials of medications and psychotherapy and were seeking relief. All had family histories of mood and anxiety disorders and documented metabolic disease in first-degree relatives. Extensive laboratory testing and bioimpedance evaluations were eye-opening because, although they were overweight, they were not aware of the extent to which they were already metabolically ill; we suspect it enhanced their motivation to adopt and maintain KMT.
This case series is limited by describing only three patients, which limits the generalizability of our results as well as the inherent selection bias, as they were interested in KMT after failing standard therapies. In addition, they were selected because their complex psychiatric comorbidity reflects the complexity seen in the majority of our outpatient psychiatric practice. This degree of complexity may limit the generalization of these findings, although it is important to note that outpatient clinical psychiatric practice as a whole has seen an increase in complex psychiatric comorbidity over the past two decades (44).
As a retrospective case series, there may be additional limiting and confounding factors, including the lack of a control group. Some rating scales and digital data are missing, which may impact the completeness of the analysis. Time to consistent nutritional ketosis and delays in obtaining necessary labs requiring intervention may have contributed to a longer time to response and remission; response and remission may occur earlier than reported here, and this deserves further research. Finally, it is not clear to what extent immersive treatment (see Supplementary material 1) and additional interventions during KMT, such as close digital monitoring, frequent clinical contact, group supports, and nature walks, contributed to the rapidity of response/remission of anxiety and depression, or to overall treatment success, independent of the biological effects of KMT, and which of these elements were most critical; more research is needed. Carefully designed prospective studies and randomized controlled trials providing higher levels of evidence are needed to examine the use of KMT and time to response and remission in individuals without comorbidity and determine the extent to which comorbidity may confound or alter these (8).
As metabolic psychiatry moves forward, we need both preclinical and larger, well-controlled clinical studies examining the pleiomorphic effects of ketone bodies in the brain and in the body to understand how we can best leverage whole foods to optimize brain energy, enhance genetic expression, reduce neuroinflammation, optimize metabolic health, and safeguard the promise of our future.
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2024.05.15 22:35 WCInvestor A Physician Disability Insurance Primer - Do You Really Need It?

A Physician Disability Insurance Primer - Do You Really Need It?
The greatest financial risk for physicians is losing the ability to turn the knowledge and skills you spent a decade learning into a huge pile of money by working in your profession for decades. There are risks that could show up in your life that would prevent you from being able to accomplish this task. One of the most common of these risks is an extended or even permanent disability. Insurance companies estimate that as many as one in seven doctors will be disabled at some point during their career. While many imagine this will occur in a sudden traumatic accident, medical illness is actually a more common cause of disability that prevents a doctor from working. Physician disability is a complicated type of insurance. This post will give you the “must-know” information to secure the best protection and help you avoid common disability insurance mistakes.

TL;DR: Key Takeaways: What Doctors Need to Know About Disability Insurance

  1. The best Disability Insurance policy is an individual, portable, own-occupation, specialty-specific policy.
  2. Purchase disability insurance from an independent agent who can show you policies from all of the major companies. We have a list of recommended Disability Insurance agents used by thousands of white coat investors each year.
  3. Buy as much disability insurance as they are willing to sell you as a resident. Include a future purchase option (sometimes called a “benefit purchase rider” or “future increase option”) and a cost of living disability insurance rider.
  4. As an attending, increase your coverage to cover both your living expenses and retirement savings if you were to work to age 65.
  5. You may get sticker shock, but the reason disability insurance is expensive is that it actually gets used. Slightly more than 1 out of 4 adults will experience a disability before they retire. Physician disability insurance agents often use a figure of 1 out of 7 doctors actually using the disability insurance they purchase. Whatever the true statistic may be, it's certainly high enough to insure against.
Do not take the risk of not having disability insurance.

What Is Disability Insurance?

Disability insurance gives you an income to live on if you become so disabled that you can no longer work.
If you become disabled, a long-term disability insurance policy pays a predetermined amount each month until you either recover from your disability or reach age 65-67. (Note: Policies vary. It is possible to buy a policy that pays to age 70 or even, for a very high premium, until death).

Why Do Physicians Need Disability Insurance?

One out of seven doctors end up having to use their disability insurance. Losing the ability to turn the knowledge and skills you spent a decade learning into a pile of money by working in your profession for decades is one of the most expensive risks that physicians face. Your most valuable asset is your ability to work.

How Does Disability Insurance Work?

Disability insurance is a pretty straightforward proposition. You buy a policy and pay your premium monthly or annually. If you become disabled, you (and your doctor) fill out the paperwork to prove it to the satisfaction of the insurance company and then they pay you the promised monthly benefit until you either recover from your disability or the insurance company meets its contractual obligation to pay the benefit.

Short-Term vs. Long-Term Disability

Disability insurance is most commonly divided into short-term and long-term.

Short-Term Disability

A short-term disability policy generally begins paying just as soon as you get disabled and then pays for a maximum period of 3-24 months. These policies are often provided by an employer as an employee benefit. Short-term disability, while inconvenient financially, is not generally a financial catastrophe for a physician saving for retirement with an emergency fund. As a result, many doctors do not buy short-term disability policies at all.

Long-Term Disability

A long-term disability policy generally does not pay immediately, but only begins to pay after a waiting period ranging from 1-24 months (typically 3 months). Then, the policy will continue to pay you a benefit each month until age 65, 67, or 70, depending on the policy. Note that a 3 month waiting period typically means your first check won't come until the end of the first month after the 3 months, so it's really a 4 month waiting period. Since losing your ability to earn a living for the rest of your life is a financial catastrophe, any doctor who is not financially independent should buy a long-term disability insurance policy.

What Does Disability Insurance Cover?

Disability insurance covers all kinds of disabilities. The best (and unfortunately most expensive) policies cover the widest range of potential disabilities.

The Definition of Disability

The most important feature is the definition of disability. Disability insurance differs from life insurance in numerous ways, but none is more significant than in defining exactly when you become disabled (and when you become enabled again). The broader the definition of disability you get in your policy, the more the policy will cost.
Unlike life insurance, where life and death are pretty black and white, disability has 50 shades of gray. You want a policy with a strong, broad definition of disability that will cover any possible type of disability? That means “true own-occupation, specialty-specific” and no limitations on things such as psychiatric conditions or addictions. This is the main difference between the “Big 5” companies and others. Even among the “Big 5,” there are slight differences. It is OK not to purchase the policy with the very best definition of disability, but the weaker the definition, the bigger the discount you should expect.

Own-Occupation, Specialty-Specific

Probably the most important aspect of the definition for doctors is that it be specific to your occupation. For instance, if I lost my left thumb, there are a number of procedures in emergency medicine that I could no longer do. I would be completely disabled from managing a busy emergency department by myself. But I could probably still go do urgent care work. A specialty-specific definition of disability in my policy would provide me with my full disability payments in addition to the money I make at the urgent care. Sometimes, the “specialty-specific” clause is inherent to the policy, and at other times it is an additional rider (a piece of paper added to the policy for which you pay an additional premium). Either way, you almost surely want to get this in your policy. Here are the various definitions, starting with own occupation and progressing to any occupation.

Own-Occupation Definition

Under this definition, your policy will pay if you cannot work in your occupation/specialty, even if you can and do work in another field and make as much money as you want.
Own-occupation policies cover people based on the occupational duties they are performing at the time of claim. If your policy includes an own-occupation definition of total disability and you are exclusively performing the customary duties of your medical specialty or sub-specialty at the time of the claim, the policy will cover you when unable to perform your specialty or sub-specialty. If you have transitioned into a different role or expanded into a new career path that requires much less direct patient contact or procedural duties, you may no longer be considered totally disabled when unable to work in your specialty or sub-specialty. This is because your “occupation(s)” involves additional material and substantial duties, no longer limited to the performance of your medical specialty or sub-specialty. In these instances, you may be considered partially disabled or not disabled at all, depending on the exact circumstances.

Transitional Own-Occupation

Your policy will pay if you cannot work in your occupation/specialty, even if you can and do work in another field. But if you exceed your previous income while you now work in another field, your monthly benefit from the policy would likely be lowered.

Modified Own-Occupation

Your policy will only pay if you can't work in your occupation/specialty AND if you are not working in another field. This definition is also sometimes called “Own-Occupation, Not Engaged” or “Own-Occupation, Not Working.”

Any-Occupation

Your policy will only pay if you cannot work in any occupation based on education, training or experience. Note that some policies are own-occupation for a couple of years and then transition to any-occupation.
One company out there (Northwestern Mutual) sells a policy with a definition that they claim is BETTER than own-occupation. They call it Medical Own-Occupation, but in reality, it is just a form of modified own-occupation. Learn more about the NML Medical Own-Occupation Definition.

Do You Really Need an Own-Occupation, Specialty-Specific Policy?

Some non-procedural physicians argue that they might not need a true own-occupation policy. They reason that if they are so disabled that they cannot practice their specialty, they probably cannot do anything else. So, they accept a less broad definition of disability to save some dollars on the premium. If you choose to do this, make sure you understand the exact circumstances under which your policy will and will not pay out.

Mental Disorders/Substance Abuse

Many policies will only cover mental illness or substance abuse-related disabilities for a period of two years. I know an attorney who couldn't practice law after developing bipolar syndrome in his 30s. It took over a decade to get it under control. He had a policy that covered mental illness indefinitely, which prevented financial catastrophe from striking him and his family.
According to the April 2011 issue of Current Psychiatry Magazine, physicians are not immune to depression and have an increased risk of suicide. Additionally, the lack of distinction between a psychiatric diagnosis and impairment stigmatizes physicians and impedes treatment.
You'll need to decide whether this is a risk you're willing to run. If you want mental illness covered like every other illness, you'll be paying more.

Presumptive Total Disability

As you well know, disability can be defined in many shades of gray. In the event of your disability, you can expect a paperwork fight between you, your physician, the disability insurance company, and maybe even your attorney. However, most policies contain a section that defines “presumptive total disability” where you can be assured there won't be much arguing from the insurance company. Even better, the waiting period will be waived and you'll start getting payments right away.
Anything short of that, and you're going to have to get your doctor to certify your disability and get the insurance company to accept it. At times, this can involve visits to multiple specialists and even hiring an attorney. Note that with some companies, presumptive disability does not need to be permanent.

Cosmetic Surgery/Transplant Surgery

Some policies will cover you if your disability is the result of cosmetic surgery or the result of donating a kidney or other body part to someone else. Others will not. Best to read your policy carefully and know what it does and does not cover.

Disability Insurance Exclusions & Limitations

Disability insurance policies generally exclude any medical conditions you have at the time of applying for insurance. For example, if you already have chronic back pain, the policy will not provide a benefit if you are disabled due to a back condition. In addition, if you admit to participating in dangerous activities such as scuba diving, rock climbing, flying, and sky-diving, the policy will likely be issued with a rider that excludes those activities from coverage. Other exclusions may also apply, such as acts of war, normal pregnancy, and foreign travel. Here is a list of common exclusions:
  • War or Act of War (this could probably be interpreted pretty broadly)
  • Active Military Duty (having served, this is pretty stupid since 95%+ of our military folks are never in any kind of serious danger of being hurt by a combatant)
  • Normal Pregnancy (don't want to work because you're eight months pregnant? Don't bother trying to get disability benefits for that)
  • Foreign Travel (varies by policy, but many don't cover you during that European vacation, much less that humanitarian trip to Sudan—read the fine print)
  • Mental/Nervous Disorder (many companies limit benefits to two years, where they might pay for “physical” disorders until you're 65 years old)
  • Medical Exclusions (any medical conditions you have at the time the policy is issued will likely be excluded, meaning if you have heart disease at the time of issuance and it leads to you being disabled five years later, the policy isn't going to pay. Again, apply when you are young and healthy and/or when you haven't had medical problems for several years to minimize this.)

Residual Disability

Residual disability refers to being only partially disabled. This may occur from the initial injury or illness or be part of the process of recovery. You generally need to buy an additional rider to cover this. Read this rider carefully, it can be a bit complicated.
Imagine developing painful lumbar radiculopathy that keeps you from working more than 20 hours a week. This is the part of your policy that will cover that. This rider will also explain how much you get if you are partially disabled. My old policy says it pays the whole benefit (total disability) if I can't earn at least 20% of my “indexed prior monthly earnings,” which is basically the money I earn at my job. It doesn't count my investments, other disability income policies, rent from a rental property, or my nonvocational activities. It doesn't pay anything if my earnings aren't reduced at least 20%. If I am making between 20%-80% of what I made previously, I get the total disability benefit times the ratio of my loss of income for that month divided by my indexed prior monthly earnings. Note that with some companies, the partial disability rider will kick in at 15%.
Some contracts use “or” in the contract and others use “and” in the contracxt. For instance, a stronger policy would trigger the partial disability rider if you had a loss of income or a loss of time or a loss of duty whereas a weaker contract would require loss of income and loss of time and loss of duty where all of those triggers must be met.

Partial Disability vs. Residual Disability

Partial disability and residual disability are generally considered to be the same thing, but there is a technical difference at some companies. For example, at one company, a partial disability rider requires total disability during the elimination period and the residual disability rider does not. With another company, partial refers to the disability, such as one that only affects one part of the body (such as one arm), while residual refers to a decrease in earnings. Either way, the key is to understand how the residual/partial rider works in the policy you actually purchase.

Recovery Benefits

A physician should consider a contract that will continuing paying them a portion of their benefits upon recovery from a disability if their income continues to be down at least 15%-20%. Most carriers will pay a recovery benefit for the benefit period although one only pays for 12 months. This is especially important for practice owners. Think if a dentist were to be disabled for 6 months and then recovers and goes back to their practice. Many of their patients may have gone elsewhere because the dentist sees his patients twice a year. It could take several years to get back to where he/she was at before becoming disabled.

Recommendations for Physicians on Disability Insurance Riders

Here's an easy cheat card to help you know at a glance what we think about all of the various riders available.
https://preview.redd.it/akf6t5iqfn0d1.png?width=800&format=png&auto=webp&s=3f8b415d0101d729fdfa51bc9147993309147d75

Who Needs Disability Insurance?

Nearly every high-income professional in their first decade or two out of school should own a policy. Your most valuable asset is your ability to work. So, if you do not own a disability insurance policy, you need to go get one, now. If you have an income, it's time to buy a policy, even if money is tight as a resident. The only exception is if you do not rely on your income to live. If you are already financially independent, it's OK not to buy disability insurance. However, even if you are frugal and married to another high earner, you may wish to still have a policy. You could both become disabled, or you could become divorced.

How Much Physician Disability Insurance Do I Need?

As a resident, you typically cannot afford to buy as much as you need, but you should be able to do so even as a brand-new attending. Basically, you need to buy enough disability insurance to cover both your living expenses and your retirement savings if you were to work to age 65 but not your taxes. Physician disability insurance payouts are generally tax-free since they are usually paid with post-tax dollars.
Note that how much you need has little to do with your income and everything to do with what you spend. The less you spend, the less insurance you need to buy. Insurance agents would love to sell you the largest possible policy (which usually works out to be about 2/3 of your gross income, but it is possible to combine two companies to get even more), so you'll need to decide how much you need on your own. Resident physicians typically buy a $5,000 per month benefit and attending physicians typically buy a benefit in the $10,000-$15,000 per month range, but there are plenty of docs who buy both more and less. If your plan in the event of disability is to rely on the income of your spouse, you may not need disability insurance at all.

Average Cost of Disability Insurance for Physicians

Unlike cheaper insurance policies like term life and umbrella policies, physician disability insurance is expensive, although not quite as expensive as your malpractice insurance. The reason it costs so much is it actually gets used. The likelihood of you acquiring a long-term disability during your working years is approximately seven times as high as your risk of dying in those years. A typical policy bought on a healthy doc in their 20s or 30s will cost something between 2%-6% of the benefit. If your monthly benefit is $10,000, expect to spend $200-$600 per month for that. Perhaps the sticker shock you get upon being quoted prices will motivate you to reach financial independence as soon as possible so you can cancel the policy.

Graded vs. Level Premiums

One way to save money on your policy is to get graded premiums. Not all policies offer this feature, but those that do will charge you less in the first few years and more in later years. Level premium policies charge you the same amount in premium every year. A graded premium policy accounts for the fact that you become more likely to become disabled as you go through life. However, it can be very beneficial to you because your need for insurance actually falls continually throughout your career as your build your retirement nest egg.
Once you become financially independent, you can drop the insurance completely. This is a good idea since the total benefits a policy could potentially pay are also dropping throughout your life (since the policy will generally only pay until you are in your mid- to late-60s). Many white coat investors who are great savers hit financial independence by mid-career. If you are one of those, you are likely to come out ahead using graded premiums instead of level premiums.

What Disability Insurance Discounts Are Available for Doctors?

Like other types of insurance, disability insurance is sold by agents who are paid commissions by the insurance companies to sell their products. It is a very competitive business. The insurance companies want agents, especially the independent agents you should be buying from, to preferentially sell their products. To incentivize the agents, they offer discounts that are only available through certain agents. Experienced, high-volume agents can often provide you with the same policy at a cheaper rate than a newer, lower-volume agent. Thus, it pays to use an experienced agent and shop around with two or three of them. Nearly every doctor should qualify for some type of discount on their policy—10%-30% premium discounts are not unusual. Types of discounts include:
  • Unisex discounts
  • Student/Resident/Fellow discounts
  • Multi-life institution discounts
  • Guaranteed Standard Issue (GSI) institution discounts
  • Association discounts
Learn more about physician disability insurance discounts.

How Do I Buy Disability Insurance?

The key to physician disability insurance is the independent agent. The agent is going to be paid a great commission by the insurance company no matter which policy you choose. Assuming policies with similar benefits, the commission isn't going to be all that different. Plus, these agents get plenty of business and none of them are starving, so they have little incentive to sell you an inferior policy for a slightly higher commission. Their reputation is worth far more than a few extra dollars in commission. Since you are (indirectly) paying the agent a very nice commission, don't feel bad about using their time and expertise to fully understand this complicated product.
For most doctors, this is a purchase that is only done once or twice in their life. Have the agent quote you different physician disability policies from each of the “Big 5” companies and show you the strengths and weaknesses of each. If you have a policy from work or your professional association, bring it in with you and have it included in the comparison. Then, you can know you made an educated decision and you can buy it and forget about it. Also, be sure to ask for a discount. The vast majority of doctors will qualify for a 5%-30% association or employer-related discount, and a top-notch agent will help you get that.

What Type of Disability Insurance Should I Buy?

There are two main types of disability policies: individual policies and group policies. As a general rule, individual policies have stronger definitions of disability. Many group policies are not own-occupation policies. Individual policies are also portable, in that you can change jobs and take them with you.

Individual Disability Policy

There are a number of benefits of an individual policy. The main one is that you are in control of all the details. You get to choose how much insurance you want to pay for. You get to choose which of the bells and whistles you are going to pay for. The policy is also “portable,” meaning you still have it if you change employers (or if your employer just decides to change the policy). As a general rule, the policy is also “stronger,” meaning it is more likely to actually pay you if you get disabled.

Group Disability Policy

A group policy provided by your employer is usually not portable, although sometimes you are allowed to take over the entire premium and take it with you. Group policies also frequently have premiums that increase every year or every five years, whereas an individual policy usually has level premiums. Group policies paid for by your employer may also pay a taxable benefit, rather than the tax-free benefit provided by an individual policy. Aside from the lower cost, the main benefit of a group policy is that it may be easier to qualify for. It may not require any sort of medical exam or blood work, and it may not ask any pesky questions about your medical conditions and dangerous hobbies such as rock climbing, skydiving, scuba diving, or flying.

How to Compare Disability Insurance Policies

The most important feature is the definition of disability. You want a policy with a strong, broad definition of disability that will cover any possible type of disability. That usually means “own-occupation, specialty-specific” and no limitations on things such as psychiatric conditions or addictions. This is the main difference between the “Big 5” companies and others.
Since disability is complicated, disability insurance policies are complicated. There are dozens of differences from one policy to another, making them difficult to compare. Use your independent agent for recommendations on what matters most. Just for an example, take a look at this chart of all the differences you could see between one policy and another.

When to Buy Disability Insurance?

You should buy disability insurance just before you become disabled. Since you don't know when that time could be, earlier is generally better. However, disability insurance is also expensive, and when you are young and poor, you have lots of other great uses for your money. A good compromise is to buy a small policy as you enter residency and then upgrade to a more robust disability insurance plan just before leaving residency. The younger you are, the healthier you are, and the fewer dangerous hobbies you engage in, the cheaper your premiums will be for the same benefit.

Best Disability Insurance for Physicians

I keep a list of those I consider the best disability insurance agents in the country. Save yourself the work of finding a good one you can trust and use the same agents that have been used by thousands of WCI readers in the past. You do not need someone local that you can sit down across the table from. It is better to have someone who has sold policies to hundreds of docs this year working with you by phone, Skype, Zoom, and email than someone you can sit down with who has only sold four policies. In addition, if there is some issue with one of these agents, I can usually help you resolve it quickly.
Information in this space rapidly changes. While we try to keep The White Coat Investor website as up-to-date as possible, our recommended agents are going to be our best source for updated information. I cannot emphasize how strongly I suggest you use them, whether buying your first policy or simply reviewing what you already have.
submitted by WCInvestor to whitecoatinvestor [link] [comments]


2024.05.14 16:13 MyFerrariMakesMeCry 69-year old father recently diagnosed with AML from having MDS. Please tell me what to expect going forward and how to best approach this.

Hello all, first post on this sub. Firstly, many thanks to everyone for the amount of useful information you give us and for how openly you talk about your own experiences. I know it cannot be easy but it's invaluable and I appreciate you for it.
My (26m) father was diagnosed with a very aggressive lymphoma back in 2019, he fought like a lion and underwent devastatingly strong chemos/treatments which saved his life but caused myelodysplastic syndrome. This obviously caused him all sorts of issues with blood platelets, white/red blood cell counts, haemoglobin et all. He has undergone 9 rounds of chemo in the past 1.5-2.5 years in order to "control" the disease. There were two occasions last year where we had to rush him to the ER because he woke up barely conscious, incoherent, with an incredibly high fever and in a frightening state; he always recovered shortly thereafter and spend a month plus in the hospital on each occasion. He was never considered for a bone marrow transplant due to age and his general health (relative to the disease) but he did get stem cell treatment which have apparently not done their job (I say this as somebody who is ignorant in the field, I'm not even sure what they were supposed to do in the first place).
A recent routine bone marrow biopsy returned a blast cell count high enough to warrant a diagnosis of AML. My father is entering hospital today to receive additional treatment to complement the one he already receiving - he is doing well and is always the same but they want him as an inpatient so they can be on "standby" in the event that whatever happened last year happens again and he's due to remain there for 30-40 days. My father is 69 years old and a plastic surgeon; he's a strong, hard-working man and has been his entire life. Took the treatments and side effects like a champ - I've seen him weaker but not frailer, I've seen him despondent but unyielding, I've seen him depressed but never tired of living. He's always been well (relatively speaking for somebody with his condition) but he's obviously had side effects of the physical (strength, endurance etc) and mental kind.
My father is my best friend and the center of my life and today I am hoping that somebody here can tell me what to expect moving forward. How should I approach this? What should I prepare for and what important information should I be aware of? I know that prognosis numbers/statistics for AML are very unfavourable but I also know that there are a number of factors that skew these excessively so I am approaching this knowledge erring on the side of caution. I have seen so much differing info on this sub alone - some say it's treatable, some say it's treatable for younger people but devastating for older, some were just saying nothing but offering well wishes; what is for certain is that this is a horrible thing to go through and a merciless ailment. I would everyone to give me their experiences, their knowledge, their everything so that I may best approach this situation.
Thanks to everyone in advance - you guys are saviours and heroes, every single one of those that post on this sub. You help so much just by writing.
submitted by MyFerrariMakesMeCry to leukemia [link] [comments]


2024.05.13 17:00 AutoModerator Weekly RP Advice Meta Thread - 13 05, 2024

Hello, and welcome to our Weekly RP Advice Thread.
The purpose of this Thread is to provide some basic guidelines for using this sub and roleplaying here, as well as allow everybody to engage in Meta discussion about the subreddit itself, such as asking for feedback about your posts or sharing some suggestions with the Mod team.
With that out of the way, here are some basic roleplaying guidelines in no particular order:
Now, these guidelines are all subjective, so we won't be enforcing them as strictly as Rules, but we do reserve the right to remove posts that we feel are not even attempting to conform to these.
How to make posts:
If you have any suggestions for other guidelines we could add to future RP Advice Threads, or even any other suggestions for us in general, please leave them below.
submitted by AutoModerator to PokeMedia [link] [comments]


2024.05.13 16:46 Independent_Leg6078 Third attempt at a reply on a throwaway account. ChanceMe!

Putting back out since I didn’t get a chance me. Throwaway acc. Rising Senior. Worried about going to a good IR school.
Demographics: Gender: Male Race/Ethnicity: White, Cajun, Creole State: Born in Louisiana, HS in SC Hooks (if they are): Military parent, dealing with a family member’s serious illness (grandfather with Alzheimer’s), Had CRPS (Complex Regionial Pain Syndrome) for a year, 100% Post 9/11 GI Bill, Going to do Naval ROTC
Intended Major(s): International Relations, Naval ROTC
ACT/SAT: ACT: 34 SAT: 1430
GPA: GPA on 4.0 scale: 3.74 Class Rank: Top 100 of 450
Coursework: AP/IB/Dual Enrollment classes: AP European History, AP United States History, AP Biology, AP Environmental Science, AP Macroeconomics, AP Government, AP Statistics, AP English Language
Awards: Beta Club Inductee National Latin Exam Gold medal and summa cum laude
Extracurriculars: Beta Club (3 years) Latin Club Officer (2 years), Member (3 years) Naval Sea Cadets (3 years) Intended to play football but was unable due to CRPS Worked at boat dealership Volunteered online for National Archives, and the Smithsonian (3 years) GWU College Intensive 6-week Program (Online)
Schools: George Washington (ED) (Dream School), Georgetown, American, UPenn, BostonU, NYU, Virginia Tech, UVA, Tulane
submitted by Independent_Leg6078 to chanceme [link] [comments]


2024.05.13 13:34 SporksOrDie What's up with the garage door?

What's up with the garage door?
Hi, my name is James Eric Waugh, and I live at the house that has "Edward Snowden was hiding in Yarmouth" plastered on his garage door.
https://preview.redd.it/mr4g0ig9970d1.jpg?width=680&format=pjpg&auto=webp&s=49b155667705624893e791ebb68ba4ec0005b707
Why did this start? Well, I asked my Veteran Affairs doctors for a medication that costs $9 a month without insurance in July 2023, it was previously given to me by the Army. My "psychiatrist" at Veteran Affairs had talked to Yarmouth Police in 2015, and since then, Veteran Affairs believed I was stolen valor. Yarmouth Police where abusing a mentally ill person with Munchausen syndrome. One of the Doctors at Veteran Affairs in Hyannis actually used to be that persons doctor at Duffy, and the first thing their new doctor told them was they had Munchausen syndrome. I would have to defend myself from many unfounded accusations with this person, including Rape, which I defended myself Pro Se in a Jury trial and was declared not guilty. The opening statement by "prosecutor" at the Cape and Island District Attorney's Office said that there was "no evidence", her testimony on the stand contradicted the police report, but I didn't bring that up in court as I had no idea how to present evidence , just like the Cape and Island District Attorney's Office.
I told Yarmouth Police and a Barnstable Court Clerk that she had Munchausen syndrome, but Yarmouth Police don't care about the truth, they are corrupt, which is probably why the CIA or whatever organization wanted to hide Edward Snowden here.
Around this time in 2015 is when I realized I was being monitored by someone on Facebook. I even told my awesome psychologist who retired that someone started watching me during one of our appointments.
But I moved on with my life, and would quit drinking in 2017ish after the state legalized Cannabis. My family had to deal with both our parents and two grandparents passing away during this time.
July 2023 is when my life started to really turn upside down. I suspect they had me wiretapped for 10 years, since they started monitoring my Facebook. I was hit by a heavy truck in July, and the trucker with car trailer tried to take off, but I thankfully was able to overtake them (they must have weighed 20 tons). Progressive insurance represented both sides of the claim, but they tried to screw me over by finding me at fault instead of the truck that hit me while i was stopped at a red light. The recommended insurance collision shop would hide the face from me that my car was vandalized and was sent to a Falmouth dealership for repairs, and for a period of time, was not in the possession of that shop or dealership. (I would find out later they bugged my car too).
After my back started to get worse after the truck accident, i was forced to return to VA healthcare. After submitting my congressional complaint to the Patient Advocate about them refusing to prescribe me anything for anxiety. One of the doctors, AFTER this, got a bigger office, and the one who originally talked to police in 2015ish retired a few weeks after filing my complaint. Unbeknown to me at the time, Veteran Affairs would only accept I was bipolar, to the point where the doctor who got the bigger office would telll me "I don't have PTSD". That really really hurt. I'm already 100% P&T rated at 100% for PTSD by VBA, but they don't care about facts like Yarmouth Police, they only care about what they can get away with.
So they prescribe me Lithium and hydroxyzine pamoate. I know I'm not bipolar, and the people who live with me and know me best believe that as well. So I only take the hydroxyzine pamoate. I asked for a supply from Stop and Shop, and when I had the 50mg of hydroxyzine pamoate, i had some really good sleep. I was even able to dream for the first time in years. But that was only a 7 day supply, VA would mail me more, but the VA issued ones despite being labled hydroxyzine pamoate would not be hydroxyzine pamoate. My Medical Records show that it was changed to "unspecified".
https://preview.redd.it/l2e2guzu970d1.jpg?width=962&format=pjpg&auto=webp&s=b556d34ef522e4e0dcfcd8f1e14e0825103ae016
After starting the VA issued drugs, i started acting weird. I would become more agitated than normal and would flip off a cop and got a ticket for it. Towards October 2023, i was become very unstable. I accused my friend of being a fed (he is), and left my cell phone at home and started driving to see what would happen. I was followed from Yarmouth Port to Long Island and back. One of the cops following me i told him my story and he said "that'll be hard to prove". I asked them to arrest me, and then drove off and followed. I would eventually come back home after these at least 10 law enforcement undercovers and Amazon Prime trucks where trying to run me off the road and incite an accident. One of them crashed into a NYC bus at a intersection.
https://preview.redd.it/ev4u8d9fty0d1.jpg?width=1536&format=pjpg&auto=webp&s=5a0dd4ec57c6ddf1745f679d8f1ac9bcd8374bd3
I day or two later, i would bring out my "VA Killed My Dad" sign and start calling my neighbors Russians and traitors. I would eventually call 911 on myself saying my neighbors where Russian spies, and my house was bugged. The ambulance had 3 people, 1 yarmouth police officer, 1 paramedic, and 1 guy who said he was a fireman then said he wasn't, he was nice. When i was asked about my medication, the YPD officer said Lithium. I had to correct the officer and tell him despite being prescribed lithium, I was only taking the hydroxyzine pamoate. The ambulance would stop and they kicked the officer out of the ambulance. The paramedic was getting texts and probably finding out about my medication change. When I arrived at the ER, the nurse was like a 40 year old hulk hogan. HUGE. I told him he could cut off my arm if he wanted while he was doing tests. Eventually he would say the word "lithium" again. But after that, i could not find any record of the word lithium in my medical records from Cape Cod Hospital. The same hospital that would claim "bipolar" on paper as hard as Veteran Affairs and Duffy soon would. No one would admit on paper i have PTSD, and would only lie and make up bipolar diagnosis.
This is when I met Edward Snowden at Cape Cod Hospital. I honestly don't remember how he entered the ER. There was a lot of people crammed into this corner, it was Snowden and 3 other "patients". 1 is a nark, heard her getting another mission at Duffy. One was the scholarship girl, must be nice getting bribes. The other was a big silent dude outside the room between me and Snowden. But he called the doctor by his first name when the doctor never said his name before that. That same "doctor (fuck you doctor josh)" said he was in the golf war and kicked me out of the yellow unit (this is where they extracted Snowden from) at the hospital for calling him a fed (they actually kicked me out within minutes of Snowden leaving). But I would only go to his Wiki page after returning from the hospital, and didn't tell anyone for a month except my undercover fed ex friend.
But the feds weren't done with me yet. They would follow me around Cape Cod and tried inciting accidents. They used my ex fed friend, lets call him puppy man. He would tell me he needed company every day, and I was a sucker and believed him. I noticed this motorcycle that kept tailing me. I would turn around up the street the day before to lose them, and the biker actually crashed in front of my house. He ironically passed the 30MPH speed limit sign and blind driveway warning going at least 45. Here's a YouTube clip of the accident. https://www.youtube.com/watch?v=xgVs9o6gQBQ
They actually blamed the car in the accident, which is the same thing Progressive tried to find me at fault when I was hit by the heavy truck in July.
I would try VA issues medications stupidly twice more and despite driving to the ROI and asking for my complete medical records, i can only find out that my hydroxyzine pamoate was changed with something "unspecified". I fired VA healthcare on January 2nd, 2024, after finding out my PTSD therapist wrote down that I told her I went to Bosnia, which is absurd, we weren't even talking about military or trauma yet, and I only was deployed to Iraq. She also said she would continue to write bipolar in her notes no matter what . Even VBA VR&E wouldn't let me go to school unless i agreed on paper i was bipolar.
I tried Duffy for 3 months hoping someone would listen to me and help me with Anxiety. My primary gave me hydroxyzine pamoate and i was doing well until I ran out. The Duffy psychiatrist who kept making excuses not to setup an appointment would declare me bipolar as my only diagnosis without ever seeing me. My undercover fed friend tried to convince me not to go to Duffy. They probably have some sort of secret office there, but I'm just guessing.
I tried posting about my theories and experiences online, but I would find out I was being censored and gaslight by some agency. They really really want to keep the lie of Edward Snowden going.
I gave up on healthcare on Cape Cod, something corrupt and horrible is going on here. I'm hoping I'll be able to get a doctor eventually that'll help me with my PTSD and not make up lies or be corrupted by our government.
The government has been screwing me over for years. My garage door is just me hoping to set the record straight.
submitted by SporksOrDie to DisabledVeteransHelp [link] [comments]


2024.05.13 07:11 Rare_Net2514 Munchausen by proxy

Does anybody else relate to this?
My father has NPD diagnosis covert subtype, along with many other dramtic, manipulative and destructive behaviours, fabrication of an illness was by far the most traumatic that resonated with me to this day.
He tried to fabricate psychiatric illnesses while pretending as if he is some form of Buddha with endless wisdom and down to earth, well-developed persona to get the recognition, attention and sympathy. At other times merely to conceal his pathology and problematic behaviours as source of whatever issue that was taking place.
I remember feeling absolutely mind-boggled and just pure anxiety in the face of these fabrications.
Having to clarify what was going on and explaining my dad's convenient use of me despite its potentially major risks felt absolutely dreadful.
I understand some offsprings of parents with Cluster-B pathology have difficulty establishing their own identity, suffer from unmet needs, and end up having similar profiles. Among those, munchausen syndrome is seen later in life and they are somewhat okay with fabricating a situation/illness that would elicit certain responses from others.
For those that understand what's going on, the depth gravity of manipulation, how did you manage?
Understanding the absence of empathy in your parent, prioritization of their wish/need even at the cost of your well being, the total disregard for your health...
Isn't it the absolute definition of nightmare??
submitted by Rare_Net2514 to raisedbynarcissists [link] [comments]


2024.05.13 01:26 chronic314 Backlash, parental alienation syndrome and co-construction

https://www.thefreelibrary.com/Backlash%2c+parental+alienation+syndrome+and+co-construction.-a0179570828
Work on the issue of sexual abuse in children and adolescents lays bare the power relations between genders, generations and social classes. The issue of gender is seen in statistics from UN agencies that report that "one in four girls and one in nine boys will be sexually abused before they reach the age of 18."(1) Generational power relations are clear because the perpetrators are adults, and the power relations of class are evident in the backlash generated by powerful sectors that have attempted to prop up the myth that child abuse is only a problem among the poor and working classes.
Webster's Dictionary defines "backlash" as "a strong adverse reaction to a political or social movement." More plainly, backlash is a negative reaction to a positive and constructive step forward. Professor of law John Myers identifies the positive step as the progress made in the past two decades with regard to child abuse and the backlash as the escalation of criticism against professionals involved in child protection.(2)
David Finkelhor was responsible for pioneering work on the sexual abuse of children in the United States. In his 1979 book, Sexually Victimized Children, Finkelhor recognizes the important contributions of the women's movement and professionals involved in child protection lobbying in drawing attention to the realities of sexual violence against minors: "If the sexual abuse of children has risen to prominence as a social problem rather quickly, it is because it has been championed by an alliance of two constituencies by now rather experienced in the promotion of social problems."(3)
In the United States, a backlash began in the 1980s under the Reagan Administration's return to stale and reactionary values following the struggles of the women's movement and the children's rights movement the 1960s and 70s.
What was once secret was now openly debated, and controversy wracked the most idealized institutions, including church, family and school. Socially consecrated myths of long-standing were crumbling: "The home is the seat of love, support and safety for children"; "Good families don't talk about sexuality"; "Churches reflect the highest moral standard with regard to sexuality"; "Children are safe in school."
By drawing attention to the realities of child sexual abuse, a solid blow was dealt to the "powers that be"; hypocrisy was uncovered; and unquestioned assumptions were challenged. This frontal attack was met with denial by means of a range of strategies developed by the fundamentalisms of faith and the market.
One of these backlash strategists was prominent forensics expert Richard Gardner, who coined the term "parental alienation syndrome" in 1985 to describe a supposed psychological disorder that he had observed in lengthy and bitter custody battles. His original paper on the subject uses the following description:
"The term I prefer to use is parental alienation syndrome. I have introduced this term to refer to a disturbance in which children are obsessed with deprecation and criticism of a parent—denigration that is unjustified and/or exaggerated. The notion that such children are merely 'brainwashed' is narrow."(4)
However, supposedly citing his original work several years later, Gardner re-describes this phenomena somewhat differently.
"[t]he parental alienation syndrome (PAS) is a childhood disorder that arises almost exclusively in the context of child-custody disputes. Its primary manifestation is the child's campaign of denigration against a parent, a campaign that has no justification. It results from the combination of a programming (brainwashing) parent's indoctrinations and the child's own contributions to the vilification of the target parent. When true parental abuse and/or neglect is present, the child's animosity may be justified, and so the parental alienation syndrome explanation for the child's hostility is not applicable."(5)
The two different definitions demonstrate the changes in this argument over time with the goal of developing a different strategy for discrediting the hard research work and harder-won social gains of the women's movement and the professionals lobbying for child protection.
Maria Jose Blanco Barea has studied the many works that Gardner published up to his death by suicide in 2003, and she suggests that "perhaps the psychological causes that led to his suicide should be taken into consideration." With regard to Gardner's professional career, Blanco Barea recounts that "Gardner dedicated the first part of his professional life to working as a forensics expert in cases of sexual abuse brought by children against their parents, students against professors, members of the faithful against representatives of organized religions and within military families. Gardner often stressed that he was a former captain [in the U.S. Army Medical Corps] and as a psychologist treated members of the armed forces who had served in Korea. He specialized in techniques to 'deprogram' U.S. soldiers who had been prisoners of war. His methodologies and expert testimony were used to question the credibility of sexual abuse victims, to prove that the accused were innocent and that the accusers were guilty of perjury. Gardner testified in cases of sexual abuse in the context of hearings to determine custody, visitation and guardianship, and he himself explains that he developed his research over the course of his career. In other words, he directly applied the scientific method of trial and error in real-life court cases that were settled while he was still carrying out his research. When he decided to publish his theories in 1985, Garner failed to provide the scientific community with the necessary data to scientifically analyze his conclusions."(6)
Richard Gardner's books were published by Creative Therapeutics, which he himself owned. Some of his articles were published in Issues in Child Abuse Accusations, a publication of the Institute for Psychological Therapies, which is directed by Dr. Ralph Underwager who is well known for an interview in the Dutch journal Paidika […](7)
In the 1970s and 80s and prior to his publication of the parental alienation syndrome, Gardner developed the "Sex-Abuse Legitimacy Scale" (SAL Scale), which he used in his own courtroom testimony. Nonetheless, Gardner's ideological stance clearly shows that he did not view child sexual abuse as a problem, except when it is denounced.
"It is of interest that of all the ancient peoples it may very well be that the Jews were the only ones who were punitive toward [adults who had sex with children]. Early Christian proscriptions against [adult-child sex] appear to have been derived from the earlier teachings of the Jews, and our present overreaction to [adult-child sex] represents an exaggeration of Judeo-Christian principles and is a significant factor operative in Western society's atypicality with regard to such activities."(8)
"The child might be helped to appreciate the wisdom of Shakespeare's Hamlet, who said, 'Nothing's either good or bad, but thinking makes it so.'"(9)
"And her [the mother's] increased sexuality may lessen the need for her husband to return to their daughter for sexual gratification."(10)
"… except for a certain amount of sexual frustration that was not gratified, the four-year-old had not been significantly traumatized by these encounters."(11)
Elsewhere Gardner had the following to say about child sexual abuse: "The sexually abused child is generally considered to be the victim, though the child may initiate sexual encounters by 'seducing' the adult."(12) Gardner even proposes that [child sexual abuse] serves procreative purposes; he maintains that although the child cannot become pregnant, a child who is drawn into sexual encounters at an early age is likely to become highly sexualized and thus will crave sexual experiences during the prepubertal years. Such a "charged up child" is more likely to transmit his or her genes through his or her progeny at an early age. Gardner states: "The younger the survival machine at the time sexual urges appear, the longer will be the span of procreative capacity, and the greater the likelihood the individual will create more survival machines in the next generation."(13) He also recommended that the incestuous father "has to be helped to appreciate that, even today, it [adult-child sex] is a widespread and accepted practice among literally billions of people. He has to appreciate that in our Western society especially we take a very punitive and moralistic attitude toward such inclinations.… He has also had back [sic] luck with regard to the place and time he was born with regard to social attitudes toward [adult-child esx]."(14)
The two definitions of parental alienation syndrome are interesting because the first reveals that the intention of the original strategy was to minimize the devastating effects that child abuse has in the victims. However, the 2002 definition added: "When true parental abuse and/or neglect is present, the child's animosity may be justified, and so the parental alienation syndrome explanation for the child's hostility is not applicable."(15) But curiously, the indicators of parental alienation syndrome also coincide with the indicators of sexual abuse that have been established by international studies on this problem.
At the time of the revised definition, the international study of child abuse and the movement to prevent the victimization of children was much further advanced. Some examples are the five European seminars "Secrets that Destroy" held in 1998 by the Save the Children Alliance; the 1999 "Vision and Reality" reports that address women's and children's rights; and a series of later publications by experts in the matter.
Although the SAL scale has been widely disregarded as a tool for diagnosing sexual abuse, Gardner's real thoughts are evident in the above citations from his works. Both the SAL scale and parental alienation syndrome represent a scandalous violation of the human rights of women, adolescents and children.
In numerous publications, Gardner uses supposedly scientific but paradoxical arguments to rationalize his denial of violence against women, defined in the Belem do Para Convention as "a manifestation of the historically unequal power relations between women and men."(16) Making use of children, he creates a new and sophisticated form of violence against women that involves complicity of the justice system.
Gardner proposed a series of symptoms that reveal three types of parental alienation syndrome (severe, moderate and mild) and specific treatment for each type. The treatment that he proposes for parental alienation syndrome involves both legal and health-care professionals, who Gardner says should have the power to administer the appropriate treatment based on the coercion, threat, change in living arrangements and, as a last resort, the internment and "deprogramming" of the child. As Blanco Barea observes, "Parental alienation syndrome makes a fraud of the law. It makes use of the declarations against discriminations against women and of the rights of the child to protect the parent and escape the application of the Conference of Vienna that protects against torture and degrading treatment, especially in the case of women and girls, and to escape the application of the Convention on the Rights of the Child."(17)
As law professor John Myers explains, "Gardner is an outspoken critic of certain aspects of the child protection system. Apparently, Gardner believes America is in the throes of mass hysteria over child sexual abuse. He writes that 'sex-abuse hysteria is omnipresent' (True and False Accusations of Child Sex Abuse, 1992, p. xxv). In his 1991 book titled Sex Abuse Hysteria: Salem Witch Trials Revisited, Gardner is harshly critical of an unspecified portion of the mental health professionals, investigators, and prosecutors trying to protect children. For example, Gardner accuses some prosecutors of gratifying their own sexual urges and sadistic tendencies through involvement in sexual abuse cases. […] It seems clear that Richard Gardner cannot claim to be balanced or objective when it comes to allegations of child sexual abuse."(18)
Although Gardner and his theories can be questioned for their misogynist and perverse ideology, in Argentina former family court judge Eduardo Cardenas published "El abuso de las denuncias de abuso" (The Abuse of Claims of Abuse) in La Ley, on September 15, 2000. Cardenas's article supported Gardner's theories and sparked backlash in our country, which has provoked widespread reaction among well-known professionals.
Perhaps the best summary of what occurred in Argentina after 2000 is found in the book Maltrato infantil: Riesgos del compromiso profesional (Child Abuse: The Risks of Professional Commitment), a collection of essays by known specialists on the issue, edited by Silvio Lamberti. As the introduction to this book describes:
"As long as the problem was associated with the lower classes, more and more cases were reported. When it began to be suspected that family violence affected all social classes and the middle and upper classes were scrutinized, a reactionary movement used the guise of good intentions to put limits on professionals that supposedly 'abused the reports of child sexual abuse.'
"This was the reaction of:
  1. Fathers who were engaged in custody battles or other legal disputes regarding visitation rights.
  2. Lawyers who preached equanimity and warned against the feminist bias that they claimed had affected the reports.
  3. Experts who tried to pass off the backlash literature from the U.S. as scientific evidence to support their own conclusions.
"This brutal attack tends to carry into an ideological realm a debate that crosses legal and psychosocial discourses, ethics and society as a whole and tries to undo the advances already gained, discouraging those who have worked to achieve these gains. In short, they intend to:
  1. Discredit reports of child abuse.
  2. Turn anyone who denounces abuse into a suspect.
  3. Blur the boundaries between victim and victimizer.
  4. Confuse the matter by citing the rare cases of violence against boys or adult men committed by women.
  5. Discredit the specialized treatment services even though the law recognizes the value of their diagnosis.
  6. Ignore constitutional norms from the Convention on Rights of the Child.
"Thus, the meaning of abusive conduct is inverted, with abuse being attributed to the person who reports the abuse and requests the fulfillment of the law.
"This reactionary backlash supports the persistence of family violence and condemns all girls and/or victims of the perpetuation of incest and abuse while attempting to stymie the legal system and the work of other professionals who until now have born the heavy burden of this process."(19)
This scientific alert went out over three years ago; nonetheless, today there are increasing obstacles to working on this issue. The notion of false reports of abuse is now firmly rooted in the courts. Sexual abuse trials are tremendous ordeals that seriously damage the children and the adults who report the crime and place a heavy burden on the professionals who take the children's part and who often face accusations of malpractice, libel or slander.
The discrediting of psychological experts is of serious concern. What started with Gardner has continued with followers who have discredited indicators, treatments, techniques and prevention campaigns. Brandishing the concept of co-construction on the part of the family members of the victims or the professionals, the testimony of the children is discredited, accused of being childhood fantasy and tale-telling.
The efforts of Gardner and his followers have been echoed by the hierarchy of the Catholic Church, an institution that claims to represent the social sexual moral but which has promoted a policy of smoke-screening sexual abuse.
The Red Latinoamericana de Catolicas por el Derecho a Decidir (Latin American Network of Catholics for the Right to Decide) has undertaken a study on the secret system of sexual abuse within the Catholic Church.(20) The ecclesiastical hierarchy always has been aware of these crimes and has implemented a policy of covering up the abuses committed by priests. This policy is summarized in the following ten points adapted from the studies carried out by the Spanish journalist Pepe Rodriguez(21) and corroborated in the studies of the Catolicas por el Derecho a Decidir:
  1. Discreet investigation of the incident. The prelates of the diocese often have ecclesiastical informants, people who desire to rise in the esteem of the hierarchy through their reports. They keep the bishops abreast of the transgressions of the priests under their authority. These reports are given orally.
  2. Initiation of actions to dissuade the aggressor and/or the victim(s). Once the prelate recognizes the situation of sexual abuse in which the image of the Church could be tarnished, the aggressor is rebuked. Then the bishops dedicate themselves to convincing the victims and their families, assuring them that the aggressor will be punished and that he has repented. They persuade the families to not report the crime so that no one in the Church or the family will suffer the consequences.
  3. Covering up the incident and the identity of the aggressor so the case never becomes public. In this effort, acts are undertaken to confuse the matter, including transferral of the priest to another parish, bribery of the victim and their family members or the use of threats and suspension of benefits (for example, expulsion from school).
  4. Measures to reinforce the cover up. When the case escapes the closed doors of the Church, the hierarch opens an internal investigation against the aggressor to defend against eventual accusations of passivity in case there is external pressure from the media or society or a civil suit. Generally, the investigation is paralyzed indefinitely. At this stage, the priest usually is transferred to another parish, another diocese or another country, depending on the situation.
  5. Denial of the incident when the case becomes public, under the argument that the priest is a man of virtue heeding God's call, a holy figure who could never commit a crime of this nature. When denial is no longer possible, the matter is treated as an exception to this rule.
  6. Public defense of the aggressor, stressing his good service to the Church and his personal merits. If he did do anything wrong, he is profoundly repentant and was not conscious of his acts. An appeal is made to the Christian sentiments of pardoning a repentant sinner.
  7. Public discrediting of the victim(s). Rodriguez uses the metaphor of ants defending an anthill to describe the corporativist attitude of the clergy when one of its members is accused. The guilt is reversed; the victim(s) and/or their family members are blamed.
  8. Paranoiac accusations of the denunciation being linked to campaigns orchestrated by "enemies of the Church." When the number of accusations is so high that discrediting the victims is not enough, the hierarchy complains that there are national or international powers or cults conspiring against the Church.
  9. Possibility of negotiation with the victim. This negotiation frequently occurs before the case is made public when the intention of the Church is to buy the victim's silence to preserve the image of the institution. When there is a public scandal, the hierarchy tries to minimize the damage by trying to negotiate the withdrawal of the accusations against the aggressor.
  10. Protection of the priest/aggressor. When the accused is found to be guilty, the hierarchy stands by him and in some cases even pays him homage or praises him, doing everything possible to erase the incident from the public memory.(22)
As the Church silences and covers up the abuses committed within its institutions, it resembles Gardner and his followers in that it denies the realities of domestic violence and the sexual abuse of children and adolescents and hampers investigation of these matters. Alliances with key judicial figures lead to perverse and scandalous rulings, such as the Melo Pacheco case in Mar del Plata, the Storni case Santa Fe or the stalling in the Grassi trial, to name the most notorious cases. Many others remain anonymous, which demonstrates the existence of a model that favors the impunity of the abusers, the suffering of the victims and the punishment of those who are working within the framework of human rights.
A sturdy thread connects those who deny, discredit, silence, minimize, distort and negotiate the rights of children: the perversity that has subordinated their ethics to systems of belief that are authoritarian, patriarchal and/or favor the domination of adults.
This ideological combination stacks the deck against victims who, for the most part, are children, adolescents and women. Women are the most discredited. In the cases in which priests are accused of sexual abuse, most people take their side, doubt the word of the victim(s) and even blame them or imply that the priests were victims of a conspiracy. Girl victims are not considered credible because they are presented as easily influenced, prone to fantasy or liars. If they are adolescents, their morals are questioned: it is argued that they already had had sexual relations before the abuse or are guilty of seducing their abuser.
In the case of domestic abuse, especially in cases of father-child incest, the mother is accused of maliciously attempting to distance the child from the father, inventing the abuse out of revenge or because she is hysterical or any other argument that serves to safeguard the figure of the father of the family or the Father of the parish. In both cases, the common sensibilities of the population are exploited: tolerance of male sexual behavior fed by the dominate sexual morality, which makes the argument of false reports even more credible than the martyrdom and accusations of the victims.
To compare the consequences that a child may suffer with the separation of his or her parents, even in a messy divorce, with the short- and long-term consequences of father-child abuse is a perverse strategy that denies the serious and profound attack on the victim's subjective integrity, which Jorge Barudy calls "attempted moral murder."
Parental alienation syndrome, the "malicious mother" and co-construction are non-scientific theories, and when used in the context of a trial, they violate the victim's constitutional rights as well as the Convention on the Rights of the Child, CEDAW and other agreements incorporated into our constitution in 1994.
We must remember that Richard Gardner's theories were developed in the United States through a method of trial and error that was applied directly in the courtroom in bitter divorce cases, which were ruled upon as Gardner was undertaking his research. In addition, the U.S. is one of the few countries that has neither ratified nor incorporated into its constitution the Convention on the Rights of the Child or CEDAW.
As Blanco Barea explains, in legal contexts based on human rights, those professionals who can carry out the therapy or treatment recommended by Gardner or his followers (such as "aversion therapy" plus the vicarious treatment of deprogramming and, as a precaution, the guarantee of visitation rights or the reversal of custody and/or total separation of the "alienating" parent and the "alienated" child) "are committing crimes of torture, obstruction of justice and legal fraud, and if they are related to the minors in question, they are also guilty of domestic violence."(23)
Child abuse, especially sexual abuse, is an alarming, universal problem. Increased attention and effective protection skills and prevention measures are necessary at family, local, national and international levels.
After a long tradition of silence, sexual abuse of children is being denounced more frequently and is becoming a topic for public and political discussion.
To alert governments and civil society organizations to the need to play a more active role in the promotion of and respect for the rights of the child (as put forth in article 19 and 34* of the Convention on the Rights of the Child) and to contribute to the prevention of child abuse, the Women's World Summit Foundation, WWSF, launched the World Day for Prevention of Child Abuse in 2000. The Day is commemorated every November 19 together with the anniversary of the International Day for the Rights of the Child (November 20). The objective of the World Day for Prevention of Child Abuse is to rally around the issue of child abuse and the urgent need for effective prevention programs.
To consolidate the global call for action, in 2001 WWSF launched an international NGO coalition that marks the World Day with appropriate events and activities to focus on and increase prevention education.
* For more information, visit the website of the Women's World Summit Foundation, https://www.woman.ch/children/1introduction.php.
* Art. 19 - States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.
* Art. 34 - States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national, bilateral and multilateral measures to prevent:
(a) the inducement or coercion of a child to engage in any unlawful sexual activity;
(b) the exploitative use of children in prostitution or other unlawful sexual practices;
(c) the exploitative use of children in pornographic performances and materials.
The author is a psychologist, a founder of the Casa de la Mujer in Rosario, Argentina, and a longtime defender of the rights of women and children.
Notes
(1.) Selected facts and figures from various UN documents, part of the 2006 Open Letter from the Women's World Summit Foundation on the World Day for Prevention of Child Abuse, 19 November. Available online at http://www.woman.ch/children/1-openletter.php.
(2.) Alicia Ganduglia (2003) "El backlash: un nuevo factor de riesgo," in Maltrato Infantil. Riesgos del compromiso profesional, Silvio Lamberti, ed., Buenos Aires: Editorial Universidad, p. 75.
(3.) David Finkelhor (1979) Sexually Victimized Children. New York: The Free Press, p. 2.
(4.) Richard A. Gardner (1985) "Recent Trends in Divorce and Custody Litigation." Academy Forum 29:2, Summer, pp. 3-7.
(5.) Richard A. Gardner (2002) "Does DSM-IV Have Equivalents for the Parental Alienation Syndrome (PAS) Diagnosis?" American Journal of Family Therapy, 31(1):1-21. See also Richard A. Gardner (2003) "The Parental Alienation Syndrome: Past, Present, and Future," in The Parental Alienation Syndrome: An Interdisciplinary Challenge for Professionals Involved in Divorce. W. von BochGallhau, U. Kodjoe, W Andritsky and P. Koeppel, eds. Berlin, Germany: VWB-Verlag fur Wissenshaft and Bildung, pp. 89-125.
(6.) Maria Jose Blanco Barea (2006) "El sindrome inquisitorial estadounidense de alineacion parental," p. 11. This document may be downloaded from http://www.revistaiuris.com/MISC/8618/borrador%20el%20sindrome%20inquisitorial%20del%20sap.doc.
(7.) The interview with Dr. Ralph Underwager was originally published in Paidika, Issue 9, 1993, and has been reproduced online at http://www.nostatusquo.com/ACLU/NudistHallofShame/Underwager2.html.
(8.) Richard A. Gardner (1992) True and False Accusations of Child Sex Abuse. Cresskill, New Jersey: Creative Therapeutics, pp. 46-7.
(9.) Ibid. p. 549.
(10.) Ibid. p. 585.
(11.) Ibid. p. 612.
(12.) Richard A. Gardner (1986) Child Custody Litigation: A Guide for Parents and Mental Health Professionals. Cresskill, New Jersey: Creative Therapeutics, p. 93
(13.) Richard A. Gardner (1992) pp. 24-25.
(14.) Ibid. p. 593.
(15.) See note 5.
(16.) From the Preamble to the Inter-American Convention on the Prevention, Punishment and Eradication of Violence against Women, also known as the Convention of Belem do Para, adopted by the OAS General Assembly June 9, 1994; entry into force March 5, 1995.
(17.) Maria Jose Blanco Barea (2006) p. 219.
(18.) John E. B. Myers (n.d.) "What is 'Parental Alienation Syndrome' and Why Is It So Often Used Against Mothers?" an excerpt from a forthcoming book titled A Mother's Nightmare: A Practical Legal Guide for Parents and Professionals. Available online at http://www.gate.net/~liz/fathers/pas.htm.
(19.) Maltrato Infantil. Riesgos del compromiso professional. Silvio Lamberti, ed., Buenos Aires: Editorial Universidad, 2003. The contributing authors were Maria Ines Bringioti, Cristina Caprarulo, Julio Cesar Castro, Alicia Ganduglia, Norberto Garrote, Isabel Gens, Eva Giberti, Carmen Gonzales, Irene Intebi, Victoria Irazuzta, Silvio Lamberti, Patricia Paggi, Mirta Pirozzo, Carlos Rozanski, Diana Sanz, Juan Pablo Maria Viar, Maria Cristina Vila and Juan Carlos Volnovich.
(20.) Regina Soares Jurkewicz (2005) Develando la politica del silencio: Abuso sexual de mujeres por sacerdotes en Brasil. Brazil: Red Latinoamericana de Catolicas por el Derecho a Decidir.
(21.) Pepe Rodriguez (2002) Pederastia en la Iglesia Catolica: Delitos sexuales del clero contra menores: Un drama silenciado y encubierto por los obispos. Barcelona: Ediciones B.
(22.) Regina Soares Jurkewicz (2005) pp. 20-22.
(23.) Maria Jose Blanco Barea (2006) p. 219.
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2024.05.12 22:02 Due_Personality_5649 Ok so I hear ppl saying the drugs cause Auto-immune disease can someone tell me more abt that?

I was on the drugs in munchausen situation that started off with the autism lable at like mid-late 12yo to early 14. My mom let me of at early 14 because she felt guilty cause I kept almost dying from the drugs. I got off the drugs at early 14 and Over a few months lost all the metabolic syndrome/diabetic weigh. So I dropped from 120 at one point to 80 pounds and then could never gain weight again. I've bee sick ever since and I don't know if it's more because of other parts of my abuse situation or more de to the drugs.
I was put back on the drugs for 2 weeks at 15 as a punishment by my dad because he was getting paranoid and accusing me of stuff. l like being pregnant (I wasn't even allowed to eat really or go outside to sit on the porch) by our old racist neighbor with dementia who peed outside and "my zoom teacher being some Asian dude from across the world who was brainwashing the class".🤣🤣🤣 Anywas when I was forced back on the drugs for 2 weeks they were putting me in 3 day comas and stuff and then my dad let me of because he said I was being good again (good while in the comas).
Then my health slowly started to plummet more and that was in 2020 (I was in comas for Christmas) and by 2021 my gut health really hit the floor. So I've been in pain, gained food intolerance, had diareah and other times constipation, blood in stool at times, pain when eating ANYTHING, pelvic pain, what has to be malabsorbtion, gas, bloating and cramping so bad I can't stand up or walk at times, etc etc ever since. There were times in my abuse situation where I was starved or just couldn't really afford food and I also went through slee deprivation abuse since 8yo, but my health didn't really get horrible till during and after the drugs. It was scary to watch my health falil because I used to NEVER get sick. I developed tooth decay cause of drug side effects and neglect and then I had a tonsl infection for a few years until I was finally allowed surgery. The tonsil infection showed that my lymphatic system was messed up.
Edit:I think I should mention the turn off the bowels side effect was a big issues for me and maybe has something to do with my gut health getting bad. I made a post abt this before and was told to get a metabolic index when ever I am able to go to a doctor again. What else should get? It's hard to even get doctors to do testing and no gaslight you but I am trying to save money for a gut microbiome test. I also was thinking maybe endoscopy or colonoscpy although I am too young for doctors to even think abt doing those.
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2024.05.12 14:09 scsresearch SCS opioid prescription history - two studies

https://twitter.com/isSCS4me/status/1739657698612850950
The publications are about the opioid prescription history of SCS patients.
The first publication reviews failed back surgery syndrome SCS patients
opioid prescription history, by Vu et al. It was a large study.
Failed Back Surgery Syndrome(FBSS) is also called Postlaminectomy Syndrome(PLS).
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788495
"
Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use
in Patients With Postlaminectomy Syndrome
...
OBJECTIVE To determine the association between SCS and long-term opioid
therapy (LOT) for PLS.
...
MAIN OUTCOMES AND MEASURES The main outcome was cessation of opioid use among
patients receiving LOT or abstinence from opioids among opioid-naive patients.
Opioid-naive patients were defined as those receiving at most 2 opioid
prescriptions per year, and patients on LOT were those receiving at least 6
opioid prescriptions per year.
...
CONCLUSIONS AND RELEVANCE These findings suggest that under real-life
conditions, SCS was associated with small, clinically questionable associations
with opioid discontinuation and not starting opioids in the context of PLS.
...
Conclusions
In summary, among all patients, SCS for PLS resulted in statistically
significant reductions in the number of opioid prescriptions in some
comparisons, but the reduction was small and its clinical relevance is
questionable. However, SCS was associated with a lower rate of new opioid use
in patients who were previously opioid-naive. Since one of the motivations to
offer SCS to patients with PLS is to decrease or discontinue opioid use, further
study is needed to evaluate this objective outcome measurement.
"
I speculate that opioid-naive SCS patients had partial success in their back
surgeries. Other factors for opioid-naive are some patients who have abdominal
issues with opioids, a patient fearing opioid addiction, over-the-counter(OTC)
pain medication effectiveness is variable for patients, etc. Opioid medication
has variable efficacy. Those opioid-naive patients increasing their opioid
prescription usage lost their "placebo" effect, or their condition deteriorated.
The experiments to conclusively prove the benefit of pain medication control
from SCS is "placebo" trials of SCS for opioid-naive SCS patients.
Some PM researchers and PM MDs would speculate that LOT SCS patients developed
a dependence on opioids, plausible but inconclusive.
The word "propitious" means promising.
"
Comparison With Other Studies
...
Our results are less propitious than those of Pollard et al. 11 who found
a large opioid-sparing effect among patients on preimplant opioids in a
meta-analysis involving 5 studies (n = 498), 4 of which were industry sponsored.
"
I have previously reviewed the Pollard et al. study and declared it biased.
It required fifteen, eight, eight, and seven years to discover these doubts for
these industry-sponsored studies.
Radiculopathy is a pinched nerve. Lumbago is low back pain. Comorbidity is the
simultaneous presence of two or more conditions.
"
However, they are more favorable than a database review involving 2374 patients
who underwent SCS paddle lead placement for a variety of different indications
including PLS, radiculopathy, and lumbago, that actually reported an increase
in post-implant opioid consumption in 5 of the 8 years analyzed (with no
statistical difference in the other 3 years).20 In this study, no pain
comorbidity was significantly associated with a greater likelihood of reducing
opioid consumption, and the criteria for defining pre- and postsurgical opioid
consumption were more liberal than ours.
...
"
The preceding quoted paragraph is data from Labaran et al. and is shared below.
"
...
"
The Labaran et al. study included patients with indications other than FBSS,
e.g., radiculopathy and lumbago. The study examined the opioid prescription
history of SCS patients.
https://www.e-neurospine.org/journal/view.php?doi=10.14245/ns.1938308.154
"
Opioids and Spinal Cord Stimulators: Pre- and Postoperative Opioid Use Patterns
and Predictors of Prolonged Postoperative Opioid Use
...
DISCUSSION
...
Upon examination of 2,374 patients who underwent implantation of a paddle lead
SCS via a laminectomy, we observed that patients with greater number of
preoperative opioid prescriptions were more likely have prolonged opioid use
postoperatively. Approximately 39.1% of patients with no opioid use
preoperatively went on to have prolonged postoperative narcotic use. This is
in contrast to SCS patients with any preoperative opioid use, where 91.97% of
patients developed prolonged postoperative opioid use. Subgroup analysis of
this population found the highest rates of prolonged postoperative narcotic
use was among patients with 4 or more preoperative narcotic prescriptions
(97.82%).
...
CONCLUSION
Utilizing perioperative opioid prescription history as a marker for patient’s
pain status, our results show that the effectiveness of SCS on patients with
preoperative opioid use remains questionable. Our findings imply that patients
with greater number of preoperative opioid prescriptions prior to SCS
implantation may not attain the same benefit from the intervention as patients
with less opioid use. These patients may benefit from additional counselling
to set appropriate expectations prior to SCS placement.
"
Again, SCS "placebo" trials are required because those patients with no opioid
usage transitioning to long-term opioid usage raise SCS efficacy questions. Did
the transitioning to long-term opioid usage SCS patients lose their "placebo"
effect?
We have two not-industry-sponsored database reviews with de-identified SCS
patient data with confounding data for SCS effectiveness for pain medication
control. The results are confusing, so we require not-industry-sponsored
multi-center studies with "placebo" trials.
I shared the Vu et al. and Labaran et al. publications with four research
groups whose research is not industry-sponsored. Let us hope for improved
studies.
I recommend reading the publications.
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2024.05.12 14:05 scsresearch SCS tolerance

https://twitter.com/isSCS4me/status/1737987400607875161
The text below is about SCS tolerance and contains theories for its origin. I
will revise and repost when new information becomes available and put new
material at the end.
SCS tolerance is the reduced effectiveness of the SCS device and, in many
instances, total failure. I have seen numbers reported in the range of 10-40%.
The condition is unpredictable.
The following two studies from the same primary author were the first valued
evidence of SCS tolerance. Chronic reflex sympathetic dystrophy is also called
complex regional pain syndrome(CRPS).
https://www.nejm.org/doi/full/10.1056/NEJM200008313430904
https://www.nejm.org/doi/full/10.1056/NEJMc055504
"
The long-term follow-up analysis demonstrates that the pain-alleviating effect
of spinal cord stimulation in chronic reflex sympathetic dystrophy diminishes
with time, as compared with that in a control group, and is no longer
statistically significant after three years.
"
https://www.ncbi.nlm.nih.gov/books/NBK555994/
"
In 20 to 40 percent of patients with a spinal cord stimulator, tolerance
develops. The effectiveness of the stimulator to provide adequate pain relief
decreases over time.[48] An estimated eight percent of stimulators are
explanted , the majority due to inadequate pain relief.[49][46][30]
"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938148/
"
Tolerance to SCS has been observed in patients where pulse amplitude needs to
be increased to achieve the same analgesic benefit over time and/or efficacy
has been lost.30,31 Tolerance cannot be predicted, and although the rate has
not been widely reported in the literature, one study that researched over
10 years found it to be in the order of 29%.32 Possible causes for stimulation
tolerance include neuroplasticity of pain transmission pathways, cellular or
fibrotic changes in the tissues around the electrodes, patients reframing their
pain over time, and psychological or psychiatric affective disorders.30
However, data pertaining to HF10 SCS have demonstrated no tolerance at this
point.22
"
The 22 reference above is industry-funded and has industry-contracted
researchers.
https://www.nature.com/articles/s41393-020-0505-8
"
Tolerance to SCS
Even in the absence of the above mentioned complications, an estimated 10–29%
of subjects implanted with epidural electrodes developed tolerance to SCS,
defined as the loss of the therapeutic effect over time, even in the presence
of fully-functioning stimulating systems [34, 43, 44]. Although an increase in
pulse amplitude might circumvent the problem for a while [45,46,47], the
tolerance phenomenon still often mitigates SCS efficacy if therapy is continued.
This phenomenon can develop as early as a few months after implantation and as
late as 10 to 15 years following implantation [29, 48]. Although, psychological
affective factors might also contribute to a tolerance to the analgesic effects
of SCS [46], there is some evidence that suggests the development of tolerance
over time results from dropped charges related to the deposit of high impedance
biological material progressively encapsulating the electrode after implantation
[46, 49]. The extent of fibrous tissue growth around the electrode has been
positively correlated to impedance increases in studies with cochlear implants
[50, 51]. It is doubtful that tolerance reflects only structural and conductive
changes on the surface of the implanted material and can be solved by merely
substituting the system. Tolerance originates from more profound changes at
the interface between the contact electrode and the underlying tissues. An
immune-mediated foreign body response is determined by the implant’s materials
and causes both the aggregation of mononuclear macrophages and the encapsulation
of the device in a collagenous envelope [52]. The picture can be further
worsened by the local toxicity of metal particles dissolved by the long-term
corrosion of electrodes [53]. All these events can activate fibroblasts, with
a consequent fibrotic growth around the electrode that causes a shallow
mechanical depression of the spinal cord regions under the array [52].
Moreover, perturbations on the surface of the cord result both in the localized
activation of glial cells, and in epidural fibrosis, which can be associated
with dural thickening or even superficial scarring, that eventually alter the
charge transfer to the surrounding neural structures [54].
"
Your disease progresses to deteriorate, and your SCS device efficacy diminishes.
The repetitive firing of the SCS device causes wind-up(sustained action) in your
nerves and eventual maladaptive neuroplasticity. Maladaptive neuroplasticity is
your brain canceling the signal from your SCS device. Your SCS signals do not
necessarily represent your standard biological nerve signals. For instance,
burst SCS and high-frequency SCS are paresthesia(sensation) free, but not for
all SCS patients. Your industry representative empirically(by experimentation)
adjusts your SCS signal to provide the patient with acceptable coverage;
entirely guesswork. Your industry representative might attempt to defeat this
theory by reprogramming every few months, but good luck because it is guesswork.
The loss of the "placebo" effect. The "placebo" effect is the neurochemicals
released when the belief of ongoing treatment exists. The "placebo" effect is
the psychological aspect mentioned in the supplied references above. SCS has a
powerful "placebo" effect.
The conclusion of revision one.
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2024.05.12 05:04 Crumbl_208 We need a recap post of MunchLea's "medical issues" along with claims of going to see a specialist/doctor. Munchausen syndrome and factitious disorder (exaggerate symptoms to appear sicker than is true) are psychiatric illnesses. She checks ALL the mental illness boxes ✅ ✅ ✅

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2024.05.11 19:13 scoobyman83 Is President Vladimir Putin a globalist and a puppet of the Chabad Lubavitchers?

Propaganda and disinformation about the President of Russia, Vladimir Putin, has been staggering for at least a dozen years. He is credited with being a globalist, a Jew, a puppet of the Jewish satanic sect of Chabad Lubawicz, a criminal, a satrap, etc., etc., etc., as well as the greatest and most powerful opponent of the satanic New World Order. He already said publicly in 2013 (there is an article on our website) that the West is ruled by Satanists. But an objective and honest assessment about Putin can only be made as evidenced by his actions, not photos with various globalist groups.
It should be added here that the leaders of the USSR and then Russia: Mikhail Gorbachev and Boris Yeltsin, who led to the collapse of the Soviet Union and then almost Russia itself, were constantly praised by the West … for betraying their countries. It is the same in Poland: traitors are praised, and patriots who care about their own country are slandered and even killed, like Andrzej Lepper.
Vladimir Putin came to power thanks to Boris Yeltsin, who realized that during his reign he was in a snare and therefore drank himself to death. However, as the successor of the perestroika form of rule with strong presidential power, he saved Russia from disintegration and division into 10 countries (the Polish Episcopate, following the Vatican’s guidelines, planned the division of Russia into dioceses and parishes after its collapse), which Colonel Słowacki made public a few years ago.
President Putin implemented his strategy of rebuilding Russia from economic and social ruins (in the late 1990s, 15 million Russian citizens died of starvation as a result of the failure to pay salaries, pensions and disability pensions in Russia – according to official statistics), he implemented step by step in the existing very difficult internal conditions (saturation with the fifth column of all circles of bureaucracy after Presidents Yeltsin and Gorbachev) and external conditions (domination at all levels of power, especially in Western countries, by NWO globalist and their satanic structures). Only the reconstruction of the Russian military, especially with the types of weapons that no one in the world has, allowed Russia, which has been patiently enduring all humiliations from the West for over thirty years, to show first its “lion’s claw” in Syria, and now, on a much larger scale, its “tiger fang” in Ukraine,
At the end of this article, we provide many links to articles about President Vladimir Putin and Russia herself published on our site over the course of 8 years. It is especially important to recall once again Albin Siwak’s talks with the Marshal of the USSR, Wiktor Kulikow, Commander-in-Chief of the Warsaw Pact Forces, incl. about who Vladimir Putin is, described in the book “Boiled Frog Syndrome” [i] and told by the author who wrote this text:
KULIKOW ON PUTIN AND THE SECRET RUSSIAN ORGANIZATION from Siwak’s book
(page 32) “… the same Zhukov also refuted the third myth. After the Second World War, the Jews proclaimed to the whole world that they would never give up power. I mean the NKVD authorities in Moscow. To this day, you can find descriptions of thanksgiving prayers in synagogues in the West. They thanked God that they had power in the USSR and would extend it to the whole world. When Zhukov shot Lavrentiy Beria at a meeting of the Political Bureau and Lazar Kaganovich lost power after Stalin’s death, and Kulikov killed two Moscow garrisons of the NKVD, the Jews of the world had a bad face… ” ;
Statement by Marshal Wiktor Kulikow to Albin Siwak (pages 40-41)“… But by the way, I will tell you that I would never go to a Jew as an adviser, and a Jew would not take me for a simple reason: I would not go, because after the death of Marshal Zhukov, I became the head of a secret organization, precisely this party “Razved”. And this organization was only established to remove Jews from all their positions and functions. That is, removing them from power and the possibility of exerting any influence on the affairs of the state and the fate of people. (…) Well, when Zhukov was carrying out this purge in the Politburo, it would not have been possible if I had not liquidated both NKVD Moscow garrisons with my own people. After all, half an hour before the time designated for the commencement of the operation, Marshal Zhukov gathered at the Ministry of Defense those commanders of the Moscow districts who had specific tasks assigned. I was ordered to liquidate these two NKVD garrisons. And the order was as follows: ~<< Everything that moves there – eliminate it. There are no Russians there. If you do not obey the order, I will have you shot. Anyway, if you do it wrong, they will kill you first. >>~ And the Jews of the world know perfectly well that I was in charge of the division whose soldiers carried out this order. To this day, it is possible to obtain figures for the liquidated two NKVD garrisons, and it is almost four thousand people. And what do you think — the marshal asked me — if Putin were a Jew, would he have accepted me as his adviser. And look at it from a different angle too. First of all, I am an officer, I became a marshal later and for the specific knowledge and trust of the highest authorities, and would I, an officer from the Zhukov school, where our honor was taught and inculcated a lot, go to the service of a Jew with my past? ~So be sure that Putin is a man of Russian roots and those who proclaim his Jewish heritage know it very well.~ But they use a very effective weapon against Putin, because we also had people who believed this nonsense or had doubts as to whether he was a Russian. I will remind you — said the marshal — that they also proclaimed your Russian lineage. We knew the Solidarity newspaper, where Mazowiecki on the front page, in capital letters, said: . “What do you say?” he asked. — The proverb says that if you throw feces on someone, something will stick and stay … … … “
[[ ]()[and] The explanation of the title is as follows: If we throw a frog into a pot of boiling water, it will get burned badly, but it will pop out of the pot, while if we slowly heat the frog slowly but surely, before it realizes it, it will cook to death. This parallel refers to the Polish nation, which is cooked step by step, step by step, and hence the dilemma of whether it will know in time, whether it will be “boiled” like a frog in a pot.]
The cited very credible, first-hand explanation about President Vladimir Putin, obtained from Albin Siwak, who is a friend of Marshal Viktor Kulikov, should suffice, as they have been quoted many times in Albin Siwak’s books and on our website. It should be added here that until his death at the age of 91 in 2013, Marshal Viktor Kulikov was a personal adviser to President Putin and Prime Minister Medvedev for many years.
This information was enough to limit various misinformation only for a few years on the Internet, because the main sewer is the mainstream media, there is no need to count on truth in every topic. But recently, the campaign to slander President Putin has grown to epic proportions due to the demilitarization and denazification of Ukraine by Russia, and above all, a firm stand against the mendacious, deceptive and criminal West ruled by satanic NWO globalists.
___ https://www.klubinteligencjipolskiej.pl/2022/04/czy-prezydent-wladimir-putin-jest-globalista-i-marionetka-chabad-lubawiczerow-dla-domoroslych-politykierow-zaplatanych-w-teorie-spiskowe-i-wlasne-miazmaty-umyslowe/
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2024.05.11 17:42 scsresearch SCS low frequency vs high frequency for failed back surgery syndrome(FBSS)

https://twitter.com/isSCS4me/status/1737922481321627726
There is disagreement on high-frequency-SCS versus low-frequency-SCS for
failed back surgery syndrome(FBSS). A not-industry-sponsored study
https://academic.oup.com/painmedicine/article/18/12/2401/4591682
and a Nevro(SCS manufacturer of high-frequency) funded study
https://pubs.asahq.org/anesthesiology/article/123/4/851/12597/Novel-10-kHz-High-frequency-Therapy-HF10-Therapy
. The not-industry-sponsored study claims identical effectiveness between the
two frequencies and less pain reduction. The Nevro-funded study claims
high-frequency is superior for FBSS. There is a significant difference between
the 12-month pain charts. The Nevro study used VAS, and the
not-industry-sponsored used NRS for pain scoring;
There is not a statistical difference between NRS and VAS pain measurements.
https://www.medrxiv.org/content/10.1101/2020.11.03.20225367v1.full
The not-industry-sponsored study pain levels for high-frequency SCS and
low-frequency-frequency SCS are nearly identical, and pain level ~6; page 9.
The Nevro-funded study reports pain levels ~4.2 for low-frequency SCS and ~2.2
for high-frequency SCS; page 12.
I am inclined to accept the not-industry-sponsored study, which means either
SCS technology is usually a six pain level.
The information below supports the above.
https://academic.oup.com/painmedicine/article/18/12/2401/4591682
De Andres et al. performed the study. For FBSS, high-frequency SCS and
low-frequency SCS implants, your outcome is usually a six pain level. It
likely means you will remain on pain medication.
https://academic.oup.com/painmedicine/article/21/7/1421/5731305
This publication is a systematic literature review of neurostimulation for
pain. Should anyone dispute De Andres et al., then reference this publication.
"However, there were significant advantages to the study, such as the lack of
industry sponsorship, a bias-reducing design, adequately powered enrollment,
and extensive efforts to lessen personnel-related bias."
The limitations of the De Andres et al. study are that it is single-center,
short-term(12 months), and has a small patient count. It is an excellent
publication.
I recommend reading the publications.
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2024.05.11 14:24 scsresearch SCS lower back pain with or without leg pain

I will declare SCS review publications with their built-in bias percentage,
i.e., the number of built-in biased publications divided by the total
publications reviewed. The industry is the SCS manufacturers. The built-in
bias is due to industry-funded studies, industry-contracted researchers,
researchers with stock in the industry, etc.
https://twitter.com/isSCS4me/status/1738237589180584165
The information below is for failed back surgery syndrome(FBSS) patients,
patients without previous back surgery history but with back pain and
of general value for those patients researching SCS.
https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/
"GRADE (Grading of Recommendations, Assessment, Development and Evaluations)
is a transparent framework for developing and presenting summaries of evidence
and provides a systematic approach for making clinical practice recommendations.
[1-3] It is the most widely adopted tool for grading the quality of evidence and
for making recommendations with over 100 organizations worldwide officially
endorsing GRADE."
https://academic.oup.com/painmedicine/article/21/11/2699/5848733
It is a literature review of several frequencies, low-frequency, burst, and
high-frequency SCS for lower back pain(LBP) with or without leg pain.
"Conclusions
According to GRADE, there is low-quality evidence that high-frequency SCS
compared with low-frequency SCS is effective in patients with axial LBP with
concomitant leg pain. There is very low-quality evidence for low-frequency SCS
for the treatment of axial LBP in patients with concomitant leg pain. There is
insufficient evidence addressing the effectiveness of burst SCS to apply a
GRADE rating."
The following quoted paragraph describes the severe deficiencies of the current
SCS research, with very few exceptions, few not-industry-sponsored studies.
"This review highlights the need for future investigator-driven, non-
industry-sponsored studies with long-term assessment. All except
six studies meeting inclusion criteria [28, 30, 41, 43–45] were
supported by industry funding. Only two studies reviewed [30, 43]
were performed by authors without industry-related disclosures, one
of which was missing a critical amount of data and another which
investigated a modified paddle implant. In general, industry-
sponsored studies report higher rates of positive outcomes [53, 54],
positive outcomes without statistical justification [55], lower rates of
adverse effects [56], and are published faster and more frequently
than trials without industry funding [57–59]. Furthermore,
publication bias has been shown to disproportionately affect evidence
that comes from small RCTs and cohort studies [60, 61], such as the
evidence base reviewed herein. Within the GRADE framework, Guyat
et al. suggests downgrading the evidence based on risk of publication
bias when “most studies are industry sponsored or likely to be
industry sponsored (or if the investigators share another conflict of
interest)” [47]. The results of this review certainly fall well within
this description. This does not, however, negate the findings of these
trials, but simply indicates the need for more investigator-driven
studies, especially since cost-utility analyses are now being
published based largely upon results from industry-funded work
[34]. De Andres et al. have provided an excellent example of an
independently funded RCT comparing traditional low-frequency with
10-kHz SCS, which demonstrated similar improvements between the
two groups at six months with regard to global pain (axial pain not
reported separately), function, mental health, and sleep quality [62]."
The built-in bias is (15/17) 88%.
Research supporting SCS for LBP with or without leg pain is weak.
SCS MDs recommending SCS for LBP with or without leg pain are on a slippery
slope. The SCS manufacturer is not a patient ally; they exist to make
a profit. The industry-contracted researchers should convert their SCS
manufacturer contracts into full-time employment; they do not represent the
best interests of SCS patients.
I recommend reading the publication.
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http://rodzice.org/