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kookingtae · 4 years ago

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the equation of love (pt. 10)

pt 1 | pt 2 | pt 3 | pt 4 | pt 5 | pt 6 | pt 7 | pt 8 | pt 9 | pt. 10

professor yoongi x uni student reader

→scenario: When you met Yoongi in a club, you thought it was fate that brought the two of you together. But after you walked into your college math class for the very first time, you weren’t so sure anymore.

→genre: smut | fluff | angst

→word count: 10.5k

→a/n: alternatively: fuck it, it’s been five years and this wip has been staring at me for three of them, so im just gonna post it. i have not read this over since 2018, so pls dont judge me too harshly hhsdg it’s unedited and probably a bit cringy, but then again what ch of teol isnt? this is NOT all that i have planned for the series, but i figured something is better than nothing, right? and perhaps the saying better later than never applies here, too. maybe one day i’ll finally get around to finishing it (by then im sure no one will even be around to remember what teol is lmao) but until then, enjoy what ive been sitting on! and as always, if you’re still here, thank you for your endless patience and support with this series <3

→another a/n: after this will probably be an epilogue!

→tw: mentions of blackmail, r*pe and sexual assault (we mostly just get closure on the whole professor lee & jun situation!!)

→warning: this chapter is not a happy ending, but it’s not necessarily a BAD one either, so for those who don’t like to finish on an unhappy note, it’s up to you on whether you’d like to read it or wait for the epilogue to be posted!

Running water.

It was such a simple yet fascinating concept—atoms and molecules coming together to form the only substance on earth that has a natural state in all forms, while having the power to kill in three different ways. Solid, by hypothermia; liquid, by drowning; gas, by suffocation. This substance can take three different forms, yet it's most commonly a liquid, covering nearly 71% of the world with translucent bodies of water. Oceans, ponds, lakes—though the most enchanting of them all were rivers. They were always moving, crashing beyond rocks and bustling with the flow of the current and gravitational pull of the earth. Rivers were passionate, and strong, and no matter how hard one tried they couldn't break the whipping tide that was pushing against them. Nothing could cause the powerful force to falter.

But, like most things, even rivers must come to an end. The current stops flowing, and the waves stop breaking around the jagged rocks, and the powerful force that seemed it would never end dulls to a still, calm lull, as if the river was nothing more than a brief yet raging storm. All the passion, all the fight—over in a blink of an eye, left to dissipate into the mysteries of the vast ocean.

Staring down at the picture on the cell phone screen in front of me was like getting pulled by the current of a river; down, down, down I flowed until there was no river left around me and I was left stranded in the middle of the sea. Yoongi and I were once raging, and passionate, and ready to fight against anyone who tried to tear us down, but now the fight was over. We had been dragged too far, fading into a body of water that was not our own. This was bigger than us.

Yes, like the flow of a river, all things must come to an end.

"That's it," Yoongi gritted his teeth, and I felt the dip of the mattress beneath me as he rose to his feet in anger.

"Yoongi," I called his name in a warning tone, warily standing up from the bed and watching him move around the room. "What are you doing?"

"I'm over it," he said, hastily throwing the first articles of clothing he could grab from his drawers over his body. "I'm done dealing with all of this, Y/N! I'm going up to the school."

Despite the flare of determination that sparked in my heart at his words, his rage seeming to radiate off of him and onto me as well, I couldn't help the trepidation that I was also filled with; Yoongi didn't have a history of making rational decisions out of anger.

"Don't you think you should calm down first?" I offered, trying my best to match his pace around the room.

"No!" Yoongi suddenly skidded to a halt in front of me, his eyes wild and crazed. "I'm going to find her and I'm going to fucking kill her!"

I could only stand with a gaping mouth and watch as he stormed out of the room, leaving me with no choice but to pull on my old clothes and chase his stomping foot steps. He grabbed his keys before storming out of the apartment, down the stairs, and outside into the parking lot. I tried to ignore the blindingly bright sunlight as I squinted my eyes and continued after him.

"Follow me up to the school," Yoongi barked as he hopped into his car.

"Yoongi–" I started, but my consoling voice was cut off by the slam of his door. I frowned, scrambling to unlock my vehicle as his engine roared to life.

The drive to the university was a nerve-wracking one. I kept a watchful eye on Yoongi to make sure he wasn't speeding or swerving all over the road; they say you're not supposed to operate a vehicle while you're upset. Though it would seem my efforts were futile, because he did in fact speed and swerve, and all I could do was frown and try to keep up.

It wasn't that I wasn't angered by Professor Lee; I was furious, rage and disgust and frustration all stewing inside of me like a pot of water that was ready to boil over. But I just couldn't help but worry for Yoongi. I had always been the non-confrontational type, always hoping that with a little time things would get better if they were ignored long enough. But it would seem that my method was proven inefficient today, because as much as I had tried to ignore her antics, that wicked woman wouldn't stop at anything to make sure Yoongi and I were properly dragged through the mud and going down like a ship engulfed in flames. Yet as much as that angered me, I couldn't bare the thought of the turmoil it was causing Yoongi. I didn't know when I had started casting my own feelings aside and putting his above—it was a gradual thing rather than one, defining moment—but it was only another factor that proved how much I actually loved this man. And that very thought instilled a fear that shook me to the very bone.

We had a lot more to lose now than just his job and my education. We could be losing us. And that was more important now than it had ever been before.

Once we arrived at the university there were a lot of screeching brakes, messy parking and fumbling hands as I scrambled to catch up to his looming figure that seemed to stalk towards the building at an unnatural pace. The pounding of my heavy heartbeat was what drove me forward, anxiety rising with each quickened step that I took.

"Yoongi!" I yelled once I had lessened the distance between us, now dead center on the campus sidewalk. "Yoongi, wait!"

All of a sudden he whirled around, his abrupt halt causing me to crash straight into his chest. I let out a yelp in surprise, eyes wide and ready to interrogate him, before I felt the smooth curvature of his palms on either side of my face as he tilted my head up to his and slammed his mouth onto mine.

The world stopped spinning for a moment, everything around me fading into the motions of his plush skin, his soft lips exploding with flavor and spilling over my tastebuds, satisfying my thirst in a way that no water ever could. I didn't even question it for a second before I was melting into him, quite literally becoming putty in his hands as the rest of the world instantaneously escaped my mind.

It's funny the way that worked—the way he was able to completely erase everything that had once existed in the blink of an eye, just by his simple touch. Whether it was magic, or I was just that fucking whipped, I didn't know. But either way, I didn't possess the power to stop it even if I wanted to.

When Yoongi finally broke away, he was breathing heavily, his breath fanning across my face in cool puffs of air. "I don't care what anyone thinks anymore," he spoke onto my lips, his forehead pressing against mine with a firm force. "Let them see. The only thing I care about is you."

It was then that I was suddenly aware of our surroundings, the reality of our world crashing down around me as I glanced around at all the eyes watching us. It varied; there were those choosing to spare us a glance as they walked to and from their classes, those who stalled their current actions to lift their heads to us not once, not twice, but three times, and then there were those who stopped altogether, their widened eyes and slackened jaws dead giveaways that they knew exactly who Yoongi was: Professor Min, Algebra 101 instructor.

A stroke of his thumb across my cheek brought my attention back to him; I stared up into his eyes, the desperate look in them captivating me and making it impossible to look away. His chest was rising and falling beneath his shirt, his fingers were grappling at my face as he brushed my wisps of hair out of the way, silently begging me to understand, to agree with him.

And in that moment, I knew what I had to do.

My lungs were filled with a breath of newfound determination, dazed and driven by Yoongi's words and embrace. "I love you," I spoke with conviction, caressing the nape of his neck as if to give him more reassurance. "Let's go.”

With that I grabbed his hand, holding my head high for the rest of the campus to see as I started up Yoongi's stride towards the school's building. He was right beside me, weaving his fingers through mine and giving my hand an extra squeeze as if to say that he was here, that he was proud to let the world know that I was his and he was mine, and that he wasn't going anywhere.

We were going to take down Professor Lee.

The seminar room was empty of students when we stormed in. Seats were placed throughout the floor, papers were scattered on the desks, and Professor Lee was at the front of the room, fiddling with the cords from the projector screen.

At the sound of the door opening, her head snapped up. "Well well well, look what we have here," she smirked when she saw us, making no plans to move as she saw me marching over to her. "You know, I really don't think–"

Slap!

The impact of my palm to her face cut off her words, skin on skin contact crackling through the room and echoing into a deafening silence.

Professor Lee gasped, immediately grasping where a red mark was now forming on her cheek before looking up at me with wild eyes. "You just slapped me!" She cried in disbelief.

"You're damn right I did," I gritted my teeth, taking a threatening step towards her and raising my palm. "Want me to do it again?"

It was then that I felt Yoongi's hand on my back, the feeling having an instant calming effect over my senses whether he wanted it to or not. I sighed before visibly relaxing and lowering my hand.

"You're barbaric!" Professor Lee was foaming at the mouth, still holding her face with a slack jaw. "Are you forgetting that I'm a professor? When Dr. Kim finds out about this, I swear he'll–"

"Tell him!" I roared as loud as my vocal chords would let me. "Tell whoever, tell the whole world, I don't fucking care! I'm done with your bullshit, you selfish psychotic witch!"

With that I gave her one final shove against her shoulders, and when both of her hands flew out to grab ahold her surroundings in an effort to keep from falling over, I planted another slap right across her face. The impact stung my hand, but I didn't care. Seeing Professor Lee stumble through the air was worth it.

"Baby," Yoongi spoke in a gentle yet warning tone next to me, and I had almost forgotten he was there until I felt his grip slightly tighten around my waist. It was a comforting hold, as if to say he completely trusted and supported whatever I chose to do in this situation, but still a protective hold nonetheless. He wanted to make sure I wasn't going to get myself hurt.

"You know, what is your problem, exactly?" I tilted my head at her as she struggled to get her bearings straight. "Is there an actual reason you're doing all of this, or are you just mentally insane?"

"It–it's not right!" Professor Lee stuttered with wide eyes, raising a shaky finger to point at me and Yoongi. "Your relationship, it's–"

"Oh cut the bullshit, Sara," Yoongi let out a sound of disgust from beside me. "We all know that's not why."

"I... I..." she stumbled for words, wide eyes glancing back and forth between the two of us. "Who do you guys think you are? You can't just storm in here and start attacking me–"

I took a menacing step forward, pure rage making up for what I lacked in intimidation. "Are you fucking kidding me?" I fumed, reaching out to grab her again.

"No, please!" She suddenly cowered before I could get to her, shielding her head away from me with her arms. "I—Yoongi, I'm in love with you!"

Her confession sent me reeling backwards in a downwards spiral, my body instantly going limp as I watched her with a dumbfounded expression. A vast silence echoed throughout the room that could be cut with a knife before she finally spoke again.

"Ever since you started working here, I knew you were the one. I just knew it." Her voice was sad, exhausted now, and a look of defeat washed over her features.

"What?" Yoongi gaped in disbelief. "Sara, that was two years ago!"

"I know!" She spat harshly. "You don't think I know that? For two years, I had to deal with this silly crush I had on you. I had to spend every day with you, watching it bloom into love overtime, and there was nothing I could do about it."

"You could've just told me!" Yoongi exclaimed as if that was the obvious answer.

Professor Lee snorted humorlessly. "Yeah, and be made a fool of? No thanks." She lowered her eyes to the ground.

"Sara, we're grown adults. You could've acted like one and fucking said something to me about it, made a move, anything but drag my career under the bus!" Yoongi's voice was strained now, his eyes wide as if silently begging her to understand him while he was equally trying to understand her.

"I was going to!" She lashed out again while whipping her head up towards him. "I was working up the courage to ask you out on a date, and then I see that fucking slut on your lap and I–"

"Don't you dare call Y/N that," Yoongi suddenly growled, pushing past me and stepping towards her intimidatingly. "One more thing out of your mouth about her and I swear to god I will kill you right here, right now."

My breath hitched in my throat at his threat and I couldn't help but weave my arm around his to grab his hand, intertwining our fingers and squeezing tightly. He gripped mine back even tighter, as if he was desperately trying to latch onto whatever calming effect I seemed to have over him.

Professor Lee swallowed, choosing to stay silent and watch him carefully as jagged breaths rose and fell from her chest. "The point is," she continued on, "I saw you with someone else—someone who wasn't me. And that completely tore my heart to shreds."

"So the only solution is to ruin our lives," I chimed in sarcastically.

"I may not have gone about it the best way," she quickly gritted her teeth and shot me a glare before turning her attention back to Yoongi, "but I had to act on instinct. I still wanted to be with you, so I figured that maybe if I split the two of you up, you would have no one else to turn to but me."

Yoongi just stared at her, his face scrunched up in a mix of confusion and disgust. "Do you know how sick and twisted that is?" He asked.

"All I ever wanted was to be with you, Yoongi," she pleaded, her tone vulnerable now as she took a tentative step towards him and started to raise her hand up to caress his cheek. "I still do. It's not too late; we can leave now, just you and me and forget this whole thing–"

"Don't fucking touch me," he knocked her hand away with his forearm just before it could reach his face. "If you think I'm going anywhere with you, you're even crazier than I thought." He then stepped back to wrap his arm around my waist and pull me securely into his side. "I'm in love with Y/N, and I don't give a shit what rumors you or anyone else wants to spread about it. You're fucking pathetic."

At that moment there was the sound of a door bursting open, causing the three of us to turn our attention to the entrance of the room. There, standing in the doorway, was Dr. Kim.

The sight of him immediately deflated the elation I was feeling from Yoongi's words, instantly replacing them with a sense of anxiety and fear that lodged its way into my throat until I was sure I would die from suffocation. This was it; according to the text from Professor Lee, he had already seen the picture of me and Yoongi kissing. This was the moment that would decide our future forever.

I just hoped we had enough evidence against Professor Lee for him to take our side.

"So let me get this straight." Dr. Kim folded his hands on the dark oak wood of his office desk. "Professor Min and Y/N had relations before Y/N became a student here, while Yoongi was unaware of her age?"

"Yes sir," Yoongi nodded his head in assurance.

"And then you continued your relationship, even after finding out that she was your student."

"He didn't at first," I interjected in hopes of getting some of the heat off of Yoongi. "He tried to call it off, but I kept pushing it. The reason we got back together during school was my fault, not his."

Yoongi's eyes met mine from the chair next to me, his gaze seeming to hold the words that silently spoke that's not true, and I instantly knew what he was thinking. In actuality, he had been the one to give me after-school tutoring on that Saturday during the homecoming football game, not I. He had been the one to kiss me first that day. But there was no way in hell I would ever tell that to the dean.

"I don't care whose fault it is; all that matters is that it happened," Dr. Kim frowned. "And it's still happening if I'm not mistaken, correct?"

"I... um," my eyes flickered to Yoongi, every fiber of my being starting to fill with panic. Shit, we should've discussed this beforehand. I wasn't going to willingly rat Yoongi out, no matter how many times he's said he didn't care anymore if people knew about us.

Suddenly I felt the warm, soft sensation of skin wrapping around the curvature of my hand that was resting atop the wooden armrest. "Yes, it's still happening," Yoongi spoke, and then his fingers were intertwining with mine.

I practically choked on my own spit at his words; did this boy have a death wish? A cough came sputtering out of my lungs, the sound causing everyone in the room to look at me until I'd settled down. Even Professor Lee leaned forward from her seat on the other side of Yoongi, bewilderment written all over her expression as she gave me a look of disgust.

"Well there's your proof right there." She threw her hands up in defeat before gesturing to the two of us. "What more do you need? Expel them, Dr. Kim."

"B–but that's not it!" I suddenly exclaimed and lurched forward, feeling the heat of everyone's stare on our embraced hands, which in turn only made me grip him even harder for support. "Dr. Kim, you have to believe me when I tell you that Professor Lee has worked hard to make my life a living hell ever since I got to this school. She had a vendetta against me; she's in love with Yoongi, and so she–"

"That's not true!" Professor Lee screeched.

"She worked to turn people against us rather than coming to you because she wanted to blackmail Yoongi into being with her," I ignored her interjection and continued. "She even made a seminar about it—the mandatory seminar that everyone attended today!"

The dean turned his attention towards her. "The seminar about the importance of practicing safe sex?" He questioned in bewilderment.

My eyes practically bulged out of my head at his words; that's what she was telling everyone it was about?

"It was!" She scrambled in defense. "I mean I... I may have brought up Yoongi and Y/N as an example, but that's only because they fit the part! Y/N had a pregnancy scare not too long ago, and I didn't want the same thing to happen to our students!"

I felt the color draining from my face, blanching it a stone cold white and decimating any feeling I had left in my body.

How the fuck did she know about the pregnancy?

My head instantly whipped towards Yoongi to see if he had any logical explanation for this, and his face was as poised and stoic as ever in front of his two colleagues—but I could see through it. I knew him well enough to catch onto the slightest falter in his blinking, the increase in heat that collected between our palms, the small twitch of his mouth that would've gone unnoticed by anyone else who observed him. I knew there was no way he could've told Professor Lee about the pregnancy, because he was just as blindsided as I was.

Dr. Kim simply raised his eyebrows in interest before turning back to Yoongi and me.

"Dr. Kim," Yoongi spoke, his voice dripping with amusement, "I mean no disrespect, but do you honestly think that if Y/N had a pregnancy scare, we would tell Sara about it? Come on; not after all she did to us."

"They—they didn't tell me!" Professor Lee huffed out a desperate breath. "I overheard them while I was–"

"While you were what?" I interrupted with a raise of my eyebrow. "While you were spying on us to find any blackmail you could use on Yoongi?"

"N–no!" She stuttered, though at this point it was obvious that she was making up lies on the spot. "While I was walking past the classroom!"

"Why would we be talking about that with the door open?!"

"Enough!" Dr. Kim barked, his deep voice rumbling throughout the small office. We all grew silent as we turned our attention to him. "There will be no arguing of he said/she said in my office," he scolded, then turned his attention to Yoongi before speaking. "I understand that there was someone you wanted me to see?"

Yoongi, who had remained calm during all of this, simply nodded his head before releasing my hand. "Yes, sir," he said as he stood up and walked towards the door.

My eyebrows were knitted in confusion as I watched it all transpire: the words exchanged between the two men, Yoongi rising out of his seat, the sight of my biology professor being revealed behind the closed door. The whole thing came as a surprise to me, and my emotions seemed to be having a war between the shock and relief that I felt raging like a storm in the pit of my stomach.

Why didn't Yoongi tell me about Professor Park being involved in this discussion? When did he have time to ask her to come? Did it even matter at this point?

"Professor Park," Dr. Kim widened his eyes, his frame physically reclining back in his seat. "I'm surprised to see you here."

"As am I to be here," she smiled though her voice was venomous, eyes flashing to a very alarmed Professor Lee.

"Mia?!" The woman barked in disbelief at her friend's entrance. "What are you doing here?"

"Something I should've done a long time ago," Professor Park replied, and with that she turned towards the dean and opened her mouth to speak.

"I'm here to testify on the behalf of Min Yoongi and Y/N."

Earth-shattering elation rippled through me from the inside out, starting at the base of my toes and spiraling to the top of my head and the tips of my fingers, causing them to tingle and buzz with a newfound sense of hope. We might actually have a chance!

"What?!" Professor Lee's voice ripped through the air in a deafening screech. "This isn't a court case! You don't get to play witness!"

"Actually, if Professor Park has witnessed anything, I would definitely like to know," Dr. Kim chimed in, raising an eyebrow towards my biology professor.

Professor Park nodded her head towards him in appreciation before speaking. "A few months ago Sara approached me in my classroom to tell me about the nasty rumors that were surrounding her and a student. She singled the student out, saying to purposely damage their grades because they were treating her unfairly and disrespecting her rules and authority as a professor; she even went so far as to say that they were sending her death threats"

"What?!" The word ripped from my throat faster than I could blink as I stared jaw-dropped at the women in the room.

"That's not true!" Professor Lee instantly protested as expected. "Sir, I can assure you that I never–"

"I have the text messages if you want," Professor Park offered in a tone so nonchalant one would've thought she was conversing about the weather.

Dr. Kim raised an eyebrow. "Text messages? I thought you said she came by your class?"

"She did, sir." Mia interlaced her fingers in front of her and bowed her head politely. "We spoke about it on multiple occasions. I asked why she wouldn't just go to you, or even the authorities if the student was making death threats, but Sara was adamant. She didn't want any scandals revolving around her so that she could maintain the level of professionalism that she had developed here."

I heard a snort coming from next to me, and it was with a swollen heart of pride that I realized the sound came from Yoongi trying to hold in a laugh.

Professionalism? Her? I had never heard anything so far fetched in my life.

Sara simply glared as Mia ignored him and continued. "She assured me that the best way to deal with this pesky student was to slowly start to fail them, and I'll admit, I was angry for her. Sara was my friend, and I respected her enough to believe what she was telling me and follow her requests." She turned her head to where I sat on the other side of Yoongi. "That student was you, Y/N. And I just wanted to say that I am so sorry for the way I handled things. You were treated unfairly and poorly due to false information."

"It wasn't false!" Professor Lee jumped in to defend herself, but everyone was pretty much ignoring her. Even the dean could tell she was playing the part of the boy who cried wolf at this point.

"I'd like to see those text messages, if you don't mind." Dr. Kim reached his hand out expectantly.

There was a brief moment of silence while Professor Park nodded and tapped away on her phone before handing it to him. His cold and calculated eyes scanned the screen while saying nothing, all three of us waiting with bated breath for him to come to a decision in his mind.

There was no where left for her to run. With these text messages, all the constant denying that Professor Lee has done will be proven false and she will be exposed for all the hell she's put me through this semester. My heart was practically bursting at the thought.

"Well I would've appreciated it if you ladies had come to me with this information instead of handling it amongst yourselves, true or not," Dr. Kim finally sighed before giving Sara his full attention. "Ms. Lee, you have three people accusing you. Even if you didn't do it, there's obviously something that's turning them against you. And here at this university we strive to hold cooperation and communication above all else. If you don't get along with the fellow staff here, then why should I believe that they're the problem and not you?"

"Um, because Min Yoongi is fucking his student?!" Professor Lee was fuming now, her upper body lurching forward in her seat and her hands gripping the arm rests for dear life. "He literally just admitted to it!"

"Language, Ms. Lee," Dr. Kim scolded calmly. "I still like to maintain a professional attitude here in my office."

"I apologize sir, but that's beside the point." She was sitting back in her seat now, though her tone was no less frantic. "Min Yoongi is in a relationship with his student, and staff cooperation or not, I don't really think that's in the teacher handbook." She raised a snarky eyebrow at us as if believing that she had finally won.

I knitted my eyebrows, my palms feeling slick with a nervous sweat against Yoongi's as I realized the bigger problem here. It wasn't whatever lies and schemes Professor Lee had cooked up with my biology teacher; it wasn't even Professor Lee herself. It was the fact that Yoongi and I were in a relationship, and that was going to have enough consequences alone to shake me to my very core with fear.

"She's right," Dr. Kim uttered the words that I was silently hoping he wouldn't say, my grip tightening on Yoongi as I anticipated whatever outcome he's decided. Our fate was in his hands.

"Of course I am." Professor Lee crossed her arms and sat back in her seat with a smug grin.

"I'm afraid I have no choice." He was shaking his head, frowning at us apologetically though the sentiment didn't reach his eyes. "Mr. Min, I am sorry to inform you that you will have to be forced to resign from our university."

The color instantly drained from my face, and with it pulling all five senses that I have into the depths of the earth until I couldn't see, couldn't hear, couldn't speak—I could barely even breathe. There was a lump that was forming in my throat and settling deep within my gut, all of this feeling fake, too fake to be real.

Yoongi was fired, and it was all because of me.

"I understand, sir."

It was Yoongi's words that were pulling me from my fog of disbelief and devastation, my eyes blinking in an effort to snap back to reality as I looked from him to the dean. "No. No, there has to be something we can do, please!" I begged, my voice starting to get frantic the more the severity of the situation hit me. "I–I'll drop out! You don't have to worry about me ever coming near here again, just please, please don't fire him!"

"Y/N..." Yoongi's voice was quiet and full of resignation, defeat, but I wasn't giving up.

"Yoongi is an amazing professor who has worked here for, what, two years? He's extraordinary at what he does and students love him. It's not easy to find a professor like that everyday." I was staring into the eyes of the dean now, trying to move him with my words. "You shouldn't throw away someone as great as him just because of some stupid 18 year old's mistake! Please, Dr Kim." I leaned forward in my seat, the room silent as I spoke. "He wouldn't be in this situation if it weren't for me. Please, let me suffer the consequences, not him."

I continued to stare in Dr. Kim's eyes, silently channeling my emotions through the pleading expression in my eyes, and it wasn't until I felt a comforting hand on my back that I was instantly drawn away into a more calm state in my chair. I gazed over at the owner of the hand, and he flashed back that smile I loved except it was sad, and it didn't reach his eyes, and I could tell there was so much he wanted to say to me right now if we weren't in the confinement of his boss' office.

"I understand your efforts, Y/N, but there's nothing I can do." Dr. Kim shook his head, and it was as if the world around me was shattering into blades of glass, scraping at my skin and leaving bloody wounds that I knew would never heal. "Mr. Min was involved in this relationship as well, and no matter whose fault it is, the professor needs to be held accountable. There is a level of professionalism and maturity that he must possess in order to work here; he's your superior, a respectable authority figure, and so he should've known better."

It was all I could do to keep from crying as I lowered my eyes and shook my head, every inch of my heart breaking for Yoongi until all that was left were tiny fragments to scatter in the wind. I couldn't believe I'd done this to him. The very thing he'd been worried about from the start—I had ruined his career.

"It is our goal as a university to see our students succeed," he continued, though I could barely hear a thing. "As for you, Y/N, I see no reason as to why you shouldn't keep attending this university."

I blinked a few times, confused. "You want me to... what?"

"You will have a suspension on your student records, mind you, and one more of those will lead to expulsion," he explained. "Though that doesn't mean that you can't keep going to school here. You will have to meet with an advisor every two weeks, though, who will be keeping a close watch on your behavior."

I could barely even believe my ears; had my hearing been completely lost due to the shock of the situation? "That's totally a double standard!" I gestured to Yoongi in disbelief.

"Y/N, it's okay..." Yoongi tried to calm me down.

"No, it's not okay!" I roared, eyes wide and brows furrowed in disbelief as I glanced at him before turning back to the dean. "Where do you think you can get off by treating people like this? This is his career—his life!"

"That will be enough from you, Ms. Y/N," Dr. Kim bellowed in a stern voice as he frowned. "I'm doing you a favor here by letting you continue your education. Speak out against me one more time and I will be revoking that offer."

His words were deafening throughout the office; it was suddenly understandable why he was so feared by those who worked under him. Yoongi started to run his hand along my spine in a soothing manner, and though it helped relax my fiery nerves and clear my foggy mind, I was still just as upset—if not more, now that the information was beginning to settle in.

"So that's it then?" Professor Lee spoke for the first time in a while, her lips pressed into a firm line, obviously disappointed by the turn of events though she didn't dare to speak out against Dr. Kim as he had warned. "Yoongi gets fired and Y/N gets a free ride?"

"Not so fast, Ms. Lee." The dean turned to her. "What you did was beyond unprofessional. You violated several school policies as well as bullied a student! Do you think that type of behavior is acceptable as a professor?"

Professor Lee opened her mouth as if to protest before slowly shutting it again, realizing that she had nothing left that she hadn't already denied. It was obvious that the evidence given to him by Professor Park, who stood silent in the corner of the room, was incriminating enough to sway his decision.

"I'm sorry to have to inform you that you will be fired as well."

"What?!" Her shrill voice screeched through the air, tearing whatever I had left of my eardrums and rendering me deaf here in this office. "What I did was no where near as bad as Yoongi and Y/N!"

"If anything, it was worse." Dr. Kim folded his hands over his desk. "Let's not forget that you managed to involve the entire student body in a false seminar that maliciously exposed one of our students and professors," he raised an eyebrow at her, "and that was just today."

"Yeah, not to mention all the other shit you did behind my back to make my life a living hell," I couldn't help from interjecting in a heated tone, though I backed off upon seeing the dean's stern gaze.

He redirected his attention back to Sara. "Here at this university, we strive to have a professional relationship, safe environment, and healthy lifestyle for our students. Neither of you achieved those three goals, so both of you will have to be let go."

Yoongi's expression simply remained placid and free of any emotion while Professor Lee's reaction was practically visceral, though neither spoke a word as heavy silence fell over the small office.

"Am I... am I still needed, sir?" It was Professor Park whose voice broke through the tension, everyone having forgotten she was there in the midst of the emotion-filled chaos. "Because if not, then I'm going to go."

"No, I'm just about finished here." Dr. Kim let out a sigh, as if what just transpired had been hard on him out of all people in the room. My blood boiled just looking at him, though I know I had to learn when to speak out and when to bite my tongue as Yoongi had taught me.

"Dr. Kim, is there any way you can reconsi–"

"That will be enough from you, Ms. Lee," his booming voice interrupted the frantic professor. "I've said all that I need to say on the matter. I'm not changing my mind."

"Dr. Kim?" I spoke up just as Professor Lee and Professor Park were getting ready to walk out the door. "I–I have something else to tell you. Un-related to this," I threw in when I saw him throw a glance in Lee's direction.

The man sighed before waving them out, leaving his office empty of visitors other than me and Yoongi in the chairs. I wasn't going to let that boy go anywhere.

"Y/N, I'm sorry that the outcome isn't exactly what you wanted but I'm afraid there's nothing I can–"

"Choi Junwoo tried to rape me," I blurted out.

There was a moment's pause as the dean was stunned silent with wide eyes, and out of my peripheral vision I could see Yoongi tense up and inhale sharply next to me.

"W–what–"

"Choi Junwoo," I spoke slowly for him so that he'd understand, "a student here at this university, tried to rape me at a frat party."

I couldn't leave the office without saying it. I couldn't leave the office without telling him. This wasn't just about me or the turmoil or trauma he caused; this was for every other girl in the future who might be a victim of Jun. Though in my heart I truthfully believed he was a good person, and that he really was just intoxicated beyond belief that night, it was still no excuse. If he had rape-tendencies while he was drunk and I didn't speak out about it, then I would be no better when it came to helping other sexual assault victims.

"Are you sure–"

"I found them at the party while he was mid-act," Yoongi jumped in, probably figuring he was already fired so there was nothing left for him to lose when it came to revealing details about our relationship outside of school. "It was... disgusting. I got her out of there immediately, but not before punching that bastard in the face."

"Metaphorically, of course!" I couldn't help but chime in, not wanting an assault charge to be on his record as well.

Thankfully Dr. Kim simply brushed off that minuet detail in favor for the more important issue at hand. "Y/N, what you're telling me will ruin this student's future. Are you absolutely sure you want to file this?"

Despite the anger that swelled up inside of me from him questioning my accusation, I still couldn't help the little trickle of doubt that crept in as I considered his words. At one point, Jun had been a friend... maybe even a potential lover had Yoongi not been in the picture. Dr. Kim was right, this information could potentially ruin his reputation, his education, his record... was I ready to carry the weight of knowledge that I've ruined someone's life forever?

"What are you talking about? Of course!" Yoongi spat an answer before I even had a chance to finish my thoughts. "She told you what happened, didn't she? Why would she speak out about something like this if she was making it up?"

"Maybe a personal vendetta?" The dean shrugged his shoulders. "People will do crazy things for revenge."

Now that got me heated. "The only one who wanted revenge here was Junwoo!" I stood up from my seat to yell. "He liked me and was mad that I turned him down. As if I owed my feelings to him or something! And when I told him no, he forced himself on me?! Is that really the type of message you want to send at this college? You know, since you're so high and mighty on "cooperation"," I did air quotes of sarcasm around my last words, my ears practically steaming with boiling rage.

"We will come out about this story, by the way," Yoongi added in, his voice full of venom. "And how will that look if you tried to keep us silent?"

"You can forget about me attending this university," I hissed.

"Alright, alright, settle down, the both of you," Dr. Kim lowered his hands in a calming manner. "I was not suggesting I buy your silence or anything of that nature. I was simply making sure you wanted to go through with this."

"Yes," Yoongi and I both answered in unison.

The dean nodded his head before clasping his hands together. "Alright."

The rest of the time in the office with spent filling on paperwork on a claim against Junwoo. I'd been given the option to be kept in the loop or even present when everything went down, though I politely declined. I wanted nothing more to do with that boy.

Though it would seem Professor Lee didn't share the same sentiment when it came to me, because as soon as soon as the two of us walked hand in hand into the hallway and Dr. Kim's door was securely shut, she sprung into action.

"You bitch!" She shrieked, not wasting another second as she leaped through the air and onto my body like a crouched tiger that was waiting for the right moment to attack. I felt the pressure of her weight against my chest and the sting of her nails scraping against my cheek, and before I knew it I was stumbling down, down onto the ground with another vicious blow to my jaw that was accompanied by her fist.

It all happened within a matter of seconds, but it wasn't long until I heard Yoongi yell Sara! and then her weight vanished just as quickly as it had appeared.

All I could do was stare with wide eyes as Yoongi slammed her shoulders back against the wall, though it was the look in his eyes that caught my attention. I had seen that expression before.

He was about to throw a punch.

"Yoongi, stop!" I cried, summoning all the strength I possessed to push myself to my feet and stumble over to the pair.

Yoongi whipped his head towards me with exasperated, almost wild eyes and his brows knitted in confusion and disbelief. "Y/N, she attacked you!"

"She isn't worth it," I spoke firmly in an attempt to get through to him. "Yoongi, just let it go. She isn't worth the trouble anymore."

It was when I placed a soothing hand against his back that Yoongi finally sighed, his stance visibly relaxing and his hands dropping from Professor Lee's shoulders. "She's right," he spit in a low, venomous tone as he turned back to her and grit his teeth. "Thanks to Dr. Kim, you already got what you deserve."

"Yoongi," there were sudden sobs that were tearing through the hallway, and it took me a moment to realize that Professor Lee was now... crying.

"Yoongi," she continued as she clung onto his shoulders. "Yoongi, I loved you!"

Somewhere deep inside of me, past all the burning hatred for what this woman has done to my life out of pure jealousy, I couldn't help but feel a twinge of sympathy for her. This was once me, heartbroken over the effects of unrequited love. Yoongi was a very sought-after man, I'd come to realize, and it wasn't about my feelings or Professor Lee's or anyone else's. It was about his.

"Sara," Yoongi sighed, and there was almost a wince in his tone from how hard he was trying to make her understand. "It's over."

"W–what?" The woman was scrambling now. "It doesn't have to be! We can go back to the way things were–"

"There never was a ‘we’!" He ripped her hands from his shoulders. "We were friends, and then you sabotaged my career and Y/N's education. You never once spoke out about your feelings, came forward, handled things like adults," he stressed the last line. "You never once did any of those things! Instead you belittled another woman and cost yourself your job all for a man—someone who until now, was your friend." Yoongi sighed again and shook his head. "I hope you get the help you need, Sara. I'm sure there is someone out there who will love you unconditionally... but that person is not me."

And with that, he put a gentle hand on my back and we walked away.

“Oh my god.”

Those were the first words out of my mouth the second we exited the building, my hands resting on my head in disbelief as I turned to Yoongi. “Holy shit, Yoongi–“

“Shhh,” he instantly consoled me, his arms engulfing me in a comforting hug and my face tucking underneath his chin as he held me close. “We did it, Y/N. It’s all over.”

I stayed in his embrace for a few moments as his words sunk in. It was all over. No more secrets, no more Professor Lee—no more anything.

“B–but your job...” I pulled away to look up at him with a shaky tone, my brows furrowed in concern. “Dr. Kim fired you, he–“

“I resigned, Y/N. There’s a difference.”

“Is there?” I couldn’t help but look up at him with a hopeless expression.

Yoongi simply nodded his head, the picture of nonchalance as if his career hadn’t just changed forever. “Yes. If I had gotten fired, it would look terrible on my resumé should I apply for another teaching position. However, given the circumstances of our arrangement...” he paused, no doubt thinking of Professor Lee, “I suppose he decided to take it easy on us all.”

My shoulders deflated in relief. “Well thank god for that...” I sighed, not even wanting to think of what could’ve happened if Dr. Kim had given us the harshest punishment. In an ironic, twisted way, I suppose I have Professor Lee to thank for that. If she wouldn’t have made my life a living hell, it would’ve been that much worse if Dr. Kim ever found out on his own.

“But none of that even matters to me right now,” Yoongi suddenly snapped, and then in the time it took me to raise an questioning eyebrow he had already grabbed both sides of my face and rammed his lips into mine, the same as he did before we went inside to confront Professor Lee.

Only this time, the kiss was different. It didn’t hold promises and potential; it held freedom. It held the success of finally getting through everything by the skin of our teeth, the relief and the pride and the pure love that we have for each other after overcoming everything that we’ve been through together. I kissed him and I didn’t care who saw—because he wasn’t my professor anymore. There were no invisible chains that bounded us apart. It was just me and him sticking together against all odds. Never in my life did I think I would ever be a part of a relationship so committed, so passionate, so determined. He and I would never stop fighting for each other.

“I love you, Min Yoongi,” I murmured against his mouth with a grin on my features that was hard to disguise—especially when I felt the corners of his lips pull up into that gummy smile that I adored with all of my heart.

“God, I love you too, Y/N,” he replied back with a content sigh, and then he continued to kiss me on the busy campus sidewalk until we were both breathless and blue in the face.

Because we now had nothing to lose.

Despite finally being released from the clutches that school had on us, the days following the meeting with Dr. Kim were not easy.

Other than having to put on a fake smile and continue attending a university where practically everyone knew about my relationship with now-former Professor Min (my mother would never let me drop out—not that I could ever tell her the reason I'd want to, anyways), there were the stresses that Yoongi was dealing with of now being unemployed. And what with all but abandoning my dorm room to instead spend my nights with him at his apartment, it was impossible to not feel the weight of his problems on my shoulders as well. No matter how many times Yoongi tried to put up a façade and reassure me that he was okay, I couldn't help but feel like this was my fault.

"If I just never would've made you dance with me at that club..." I'd say at times, unable to keep from tracing back each and every one of our interactions and blaming myself.

"Cut that out," Yoongi would snap.

"What? It's true!"

"You know I don't like it when you talk like that!" He'd turn to me with a stern tone. "I don't regret anything that happened between us, okay? Not one single bit." There was a heavy silence as his words would hang in the air. "If you wouldn't have asked me to dance, then who knows if I ever would've worked up the courage to kiss you? And I wouldn't be here, sharing this bed with the love of my life."

"Aw, Yoongi..."

And the two of us would make love, again and again until we'd have a similar argument some time later and repeat the whole process all over again. I'd feel guilty, Yoongi would remind me of exactly how much he doesn't regret meeting me, and we'd get lost in each other's embrace.

That is, until a simple Sunday morning suddenly changed everything.

"I got it."

I casually peered over at the sound of him from my spot in the living room, sitting criss crossed on the couch in my pajamas with a laptop in my lap. "What?"

"The job." Yoongi's voice was low, serious as he stared at the paper in his hands that had previously been so carelessly disregarded on the kitchen island along with the Sunday paper. "At the university in Seoul."

"Wait." He had all of my attention now as I sat the laptop on the coffee table and rose to my feet. "Like the Seoul National University university?"

"Yeah," he let out a single chuckle of disbelief before he pressed the paper against the counter and turned to me. "I got the job."

"Oh my god, Yoongi!" I exclaimed with my own chuckle of disbelief before running forward and wrapping my arms around his neck. His arms immediately engulfed my waist and lifted me off the ground as we spun around in place, my lips instantly finding his in a searing kiss that was full of passion and excitement to match our current mood. "That's amazing!"

"I know," he replied as he placed me down. A tentative smile was frozen on his lips as he stared off into the distance before letting out another sound of disbelief, his head shaking before his palm slid down his face. "I can't believe it!"

"I'm so proud of you!" I mirrored the grin of pure elation on his features, my chest swelling with joy and relief and most of all, pride.

I was so, so proud of Yoongi. I knew how much his job meant to him, and the feeling of guilt that weighed down on me from knowing that I was the one who inadvertently took that away from him, that I was the one who inadvertently caused all this stress of job hunting was instantly lifted off my shoulders. I knew how much he wanted this. I knew how hard he had worked to get this job at such a prestigious school, and god damn it, I knew how much he deserved it. If Yoongi was anything, apart from being an amazing person and a wonderful lover, he was great at his job. He was a natural born teacher.

Though no matter how many times I've willingly showered him with endless compliments about his work, he'd blush sheepishly and simply swat away all of my words with a simple kiss, or an "if you don't shut up your food is going to get cold. We're unemployed now; we need all the nutrition we can get. Haven't you ever heard of the Great Depression?"

So instead, I just chose to beam at him while he basked in the euphoria of the moment that this job acceptance brought on. After all, I knew he was well aware of how proud of him I was and how supportive I'd always be when it came to anything he wanted to accomplish.

Though the bliss was short lived.

I watched as Yoongi's expression slowly fell, the smile on his face slipping into a deep frown and his eyes turning to stone. "No."

"What?" I furrowed my brows, concern filling me and etching onto my features as I cupped his cheek in my hand, trying to figure out why his mood had changed so suddenly. "What's wrong?"

"I'm not taking it." His tone was cold, definitive, as if the subject wasn't even up for debate as he grabbed the letter.

"Wait wait wait," I hurried to stop him from tearing it in half. "What are you talking about? Why not?"

He turned to look at me with cold, incredulous eyes, as if he couldn't believe I was even asking a question so stupid. "The university is in Seoul, Y/N."

"Okay...?" I shook my head in confusion, still not understanding what the issue was. "And?"

"I'd have to move." He was taking the paper back out of my hands and ripping it right down the middle before I got the chance to stop him.

I suddenly deflated, the severity of his words dropping in my stomach and wrapping around the anchor of my heart, sending it down, down, down through the floor of his apartment and hurdling towards the center of the earth.

"...What?"

"I'd have to move away from you."

And there is was, the bomb detonating an explosion and demolishing whatever was left of my heart.

"No... t–there has to be another way, there has to–"

"Seoul is hours away from here, Y/N," Yoongi barked out, his tone angry and harsh as it always was when he was upset. "It's on the other side of the country; there's no way I'd be able to commute without living there."

"Okay, so why did you apply then?" I couldn't help but snap back defensively. "You knew the distance to Seoul prior to applying for the job. Why even bother if you're just going to get pissed about not taking it?!"

"Because I didn't think I'd get accepted!" His voice was loud, almost yelling now. "It's the most sought after, prestigious school in the fucking country and I didn't think some young idiot who got fired from his last job would be able to get in!"

It was silent as his words settled over the atmosphere, clinging to the air that filled the room around us and encasing my lungs until it was impossible to breathe.

"What the fuck are you talking about?" I finally hissed. "You're a great teacher, and you know it. If anyone's a young idiot here, it's me!"

Yoongi scoffed with a shake of his head. "I'm the one who kissed you again during that tutoring session after telling you to stay away. I'm the one who fucked you against that desk." His tone was low now, and his eyes seemed to grow harder in realization with each step that he took towards me. "I'm the one who asked to take you out on that fucking date and I'm the one who pulled you onto my lap when Sara caught us in my classroom! God damn it, I'm the one who tracked you down at a fucking frat party and punched one of my students!"

His voice slowly raised until he was yelling again, and if it weren’t for the fact that he was now standing chest to chest and cornering me up against the countertop of the island, I would've winced at the loud volume so close to my ears.

"Stop blaming yourself, Y/N, when I'm the one who was the authority figure. I'm the one who should've had my shit together, but I just couldn't around you!"

I felt myself soften at that. As angry and intimidating as he seemed right now, surely frightening whoever would come into contact with him when he was like this, I knew that it was all a front. Yoongi wasn't the best at dealing with emotional situations—he'd all but bite my head off any time I even tried to mention his father—and sometimes lashed out in anger when he was upset or hurting inside. I knew how badly he wanted this job; I could see it in his eyes, hear it in his voice when he'd first submitted the application. And now, when the career position of his dreams was finally right under his nose, he couldn't have it. Because I was holding him back.

"You have to take it." My voice was solemn and steady as I stared him in the eyes.

He instantly frowned. "What? No, I–"

"Yoongi."

He fell silent, all signs of anger and malice wiped from his features once he saw just how serious I was being. A soft, bittersweet smile that had nothing to do with happiness slowly tugged at my lips as my eyes gleamed with pain. My heart was breaking with every word I was speaking, but I knew it was something I needed to do.

"You have to take the job."

The silence that ensued my words only further proved my point, simultaneously stabbing a knife into my chest with each passing second. He knew I was right. He knew it. He just didn't want to hear it.

"You don't..." He sounded smaller, more pitiful and confused as he tried to make sense of what I was saying. "You don't want me to stay?"

The hurt, the sadness, the utter hopelessness in his voice absolutely crushed me. I couldn't help but fall into his embrace, wrapping my arms around his chest and squeezing tightly as if I could somehow hold the pieces of him together that I knew were breaking. The severity of what was happening, of what I was doing started to settle within me the moment I heard his voice break.

"I do, baby," I replied, the sound muffled by the skin of his neck that my face was buried in as a sob threatened to claw its way out of my throat and swallow me whole. "God, you know I do. But you can't."

"Y–you can come with me." He was shaking his head now, his hands gripping at the shirt on my back with closed fists while he desperately tried to hold onto me, as if I would disappear beneath him at any moment. "We can move together to Seoul and you can–"

"You know I can't, Yoongi." It was my turn to shake my head, and with it came a heavy tear that fell down my cheek. "I have to go to school. I have a family who's helping pay for my tuition, and my mom— you know it's not all up to me."

I heard him sniffle as he pulled away, and even though I felt no evidence of tears from him against my skin or my shirt, his eyes were bright red when he stared back at me.

"I'm not leaving you, Y/N."

The sheer determination in his voice had me shattering like broken glass. "I'm not letting you do this, Yoongi. I'm not letting you waste this opportunity. Do you know how many people are waiting to work at Seoul University? How many professors would kill to be in your position?" I kept my gaze steadily on his as I slowly shook my head. "I care about you... so fucking much. I've never loved someone so much before... not like this." I paused, asking myself one last time if this was really the decision I wanted to make as my words settled in. I took in the sight of his beautiful, breathtaking features silently begging me not to do this. "I'm putting you above my selfishness," I finally decided with another shake of my head. "You need to do this Yoongi, for you. You know you do."

Yoongi slowly shook his head, though the expression on his face told me he knew I was right. "I don't want to lose you," he spoke as a tear spilled over the brim of his eye, dampening his lashes and leaving a wet streak in its wake as it rolled down his cheek, and the sight was the final breaking point that had me bursting into tears.

"Neither do I."

His fingers dug into my skin as he tightened his grip on my body, his forehead leaning against mine as the only sounds exchanged between the two of us were the unspoken words of labored breaths and soft sobs.

Sometimes when you love someone, you have to do what's best for them.

And I knew this was what's best for Yoongi.

#yoongi fanfic #yoongi x reader #yoongi smut #bts fanfic #bts smut #lmao why am i so impulsive #i decided i was gonna post this all of ten minutes ago and here we are #anyways this will help my peace of mind to know that at least SOMETHING is out there #some sort of closure to the series #not everything i had planned but #it'll do for now #i hope u guys can forgive me for whatever tf this is fjshgdkfd

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mosquecannon17-blog · 4 years ago

Text

Is A Follistim treatment Right For You?

vaginal Canal tightening device.

Content

Do I need a Gp referral For Facelift surgical Procedure?

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Which locations Can Be treated With Hifu?

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Why Are Cars Facelifted?

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Less typical impacts consist of small discoloration as well as skin level of sensitivity. The dimension of the treatment area as well as the strategy picked impacts the duration of the HIFU treatment session, which can vary in between 30 and also 90 minutes. We will certainly have the ability to provide you a quote during your appointment. In the past I have actually tried all sorts of systems to assist with my stretch marks and also lower as well as tighten my child stubborn belly after the birth of my youngsters. The only treatment that I have seen outcomes with is the Lipofirm Pro!

What surgery makes you look younger?

A facelift, which is also known as a Rhytidectomy, will give an individual a relaxed and younger appearance. In order to be a suitable candidate for a facelift, an indiviudal should have adequate skin elasticity to ensure the procedure is effective.

This includes moving the handpiece over the area as well as providing pulses of power to achieve the desired result. Your therapy may be a little unpleasant however should not be painful and any type of discomfort must rapidly diminish promptly after treatment. At your appointment, we will certainly take a full case history and also evaluate your suitability for the treatment. We will then coordinate a custom therapy strategy with you, based upon your issues and also what you wish to achieve from the treatment. Very hardly ever one may experience small soreness for a couple of hours after the therapy in addition to swelling or tingling in the therapy location for up to a few weeks. There may also be wounding as well as feeling numb on dealt with areas but this ought to settle 2-4 weeks following the procedure. Ultraformer III has been called the comfortable choice to surgery and also Ultherapy.

Do I required a General Practitioner recommendation For Facelift surgical Treatment?

You might have an MRI scan and also numerous samples of prostate tissue taken. This will give the medical professionals a clear image of where the cancer is in the prostate. HIFU can be offered to the whole prostate when there might be cancer in greater than one area, so that all areas of cancer are dealt with. You might additionally have other tests, such as a CT scan, MRI scan or bone check, to see if the cancer cells has actually infected other parts of your body. A continual surge in your PSA degree can be an indication that the cancer has returned. If your cancer cells does come back, your physician or registered nurse will chat with you about additional therapy alternatives.

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A lot of people endure the therapy well while the power is being delivered. Discomfort and also discomfort related to the treatment are temporary and also are just experienced throughout the therapy. A three dimensional alternative to an intrusive facelift, without any cosmetic surgery and no down time. All skin consultations will be done by phone to evaluate your viability.

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After my training course and a little Physio I am entirely back on form. The therapy really helped me get my self-confidence back, as well as the will to begin training once again. Tone, tighten up and also strong skin on your confront with this pioneering therapy.

Results from tests and very early cases in the very first 5 years are extremely motivating with way of living results far better than many various other typical treatment options. The HIFU procedure normally lasts between 1-4 hours, depending on the size of the prostate, as well as is either done under basic anaesthesia or an epidural as well as IV sedation.

Which locations Can Be treated With Hifu?

What Is Mole, wart and Skin Tag Removal?

Our reference campaign deal is valid whatsoever centers for any kind of plan. Share this page to your pal and then get in the coupon code, "FRIEND30" when scheduling your Free assessment. The HIFU treatment is perfect for those individuals who intend to boost their face, tighten up the skin as well as overall battle indicators of aging. Whilst the therapy doesn't harmed, you may experience minor pain throughout the treatment, similar to a light prickly feeling. Did you know that you can schedule your appointment in either of our aesthetic facilities in Nottingham or London? We're devoted to supplying a high quality, personal and also practical solution for each and also every one of our clients, making it as very easy as possible for you to gain access to our very skilled experts. Schedule in at our Nottingham or London facility today, we can't wait to see you soon.

These men will certainly have regular examinations to watch on the cancer that is not treated. Some guys who have focal HIFU have only one location of cancer cells in their prostate. Focal HIFU deals with a smaller location of the prostate and takes one to 2 hrs. It might be suitable for guys who have cancer that requires dealing with in just one location of their prostate. You may have a catheter placed in at the beginning of the therapy to drain pipes urine out of your bladder. A catheter is a slim tube that is passed into your bladder, either with the penis or through the wall surface of your abdomen. You will have a general anaesthetic so that you're asleep during the therapy.

On the early morning of your HIFU treatment, you'll be offered an enema to clear your bowels. You'll additionally be asked not to eat or consume for around six hrs prior to your HIFU. If you're having focal HIFU, you will typically most likely to a testing appointment initially

One of the large advantages of the HIFU Facial is that it's a non-surgical therapy that can be done in a single treatment.

You can see the results quickly, and also the renovations remain to be seen for up to nine months as your collagen is restored.

HIFU is secure, effective and also an excellent solution for training and tightening the jowls, minimizing great lines around your eyes, nose as well as mouth, tightening your skin around your jaw and also neckline as well as reducing hooded, saggy eyelids.

High intensity focused ultrasound is in some cases made use of as a therapy for very early prostate canceror prostate cancerthat has actually returned after radiotherapy.

Rather than surgery, the Ultraformer harnesses ultrasound innovation to radiate energy to the SMAS layer to tighten, lift and plump the skin.

Focal therapy making use of high-intensity focused ultrasound for localized prostate cancer.

It is given as component of a scientific trial, so it is just available in some medical facilities in the UK.

Because of this, it's only readily available in specialist centres in the UK or as part of a medical test.

These tests will certainly help your specialist target the area of the prostate that requires to be dealt with. As Lipo Sculpt offers a Coolsculpt Surrey is reasonably brand-new understanding regarding the long-lasting advantages as well as results is raising daily.

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How much does a ponytail facelift cost?

Cost: $8,000–$11,000. The Hair Trick: A DIY ponytail placed just right will yield impressive results too, even if only for an evening.

Transurethral resection of the prostate is a procedure to eliminate prostate tissue as well as improve the circulation of urine. This operation is sometimes used before HIFU to lower the danger of some urinary system troubles after the therapy. Ask your physician or registered nurse which kind of HIFU might be ideal for you. HIFU could be suitable for you if your cancer cells is had inside your prostate. The Content on Our Website does not comprise advice on which you must rely. Professional or specialist advice must constantly be sought prior to taking any kind of activity associating with clinical aesthetic treatments.We make reasonable initiatives to ensure that the Web content on Our Website is full, accurate, and up-to-date.

Why Are Cars Facelifted?

Can a facelift help smokers lines?

Unfortunately, a facelift is not effective at treating those all too common lines around the mouth (smoker's lines). Even patients who do not smoke can develop these lines, sometimes fairly deep. To correct those, a resurfacing procedure needs to be performed.

HIFU treatment takes mins, during treatment it is common to experience some pain as well as a tingling feeling relying on the intensity of the ultrasound. This introducing treatment uses the current cosmetic modern technologies to help tone, tighten and also solid skin on the face, which assists to lower the appearance of fine lines and wrinkles as well as leave the skin looking rejuvenated as well as younger. We can quote the rate for treatment after a preliminary complimentary consultationwith you. If the person selects a body contouring therapy, fat cells are gotten rid of using lipolysis.

Ideal cosmetic results are achievable with just one therapy session, the study images below give an instance of the results from HIFU treatment. targets adipose tissue by using high-intensity ultrasound power creating thermal coagulation to fat cells. The energy generated penetrates below the skin surface and creates mobile friction within cells. As aesthetic medication has advanced, ultrasound has verified to be an outstanding tool for a number of medical procedures. Complete Body Care offers innovative Skin Firm treatment for the face and body utilizing High Strength Concentrated Ultrasound. An usual adverse effects of ageing hangs, sagging skin, triggered by the exhaustion of collagen as well as elastin in the dermis. Ecological elements such as sunlight damage and smoking can better decrease degrees.

If you have focal HIFU, you might have low-risk cancer in another location of the prostate that is not dealt with intentionally. You will have routine tests to keep an eye on the cancer cells that is not dealt with. These might consist of PSA examinations, MRI checks, and also prostate biopsies. You might have a few of the adhering to symptoms directly after therapy, or they may establish time later on. Talk with https://southampton.lipo-sculpt.co.uk/ or nurse if you have troubles with erections or other sex-related problems. They can discuss your therapy alternatives as well as organize complimentary therapy on the NHS. Some males have troubles getting or keeping an erection after HIFU.

What is the best face tightening procedure?

Laser resurfacing This is the most effective procedure for tightening loose skin. Unlike the laser treatment described above, this procedure requires some downtime. You'll need to stay home for 5 to 7 days. Laser resurfacing also gives you the fastest results.

If you aren't able to have a basic anaesthetic for health and wellness reasons, you might be able to have a spine anaesthetic to ensure that you can't feel anything in your lower body. With this, you will also be provided some medicine to make you drowsy.

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What Can I expect throughout My Cryopen therapy?

This is since it can damage the blood vessels and also nerves that control erections. For some males this will certainly enhance, but for others this will be a longer-term side effect of HIFU. The following adverse effects can establish right after your therapy. If you have hormone therapy or a TURP before you have HIFU, these can additionally create side effects. Various other males have an additional area of cancer cells in their prostate that is not treated on purpose. This cancer cells is not treated since it is less most likely to spread out (low-risk cancer cells) and it might not trigger any type of troubles.

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thirteenthspirit · 6 years ago

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“People don’t kill themselves over love” (Part IV)

Link to part 1 “I would, my friend, Fernando”: http://thirteenthspirit.tumblr.com/post/182269822949/i-would-my-friend-fernando-part-i

Link to part 2 “I wish I hadn’t”: https://thirteenthspirit.tumblr.com/post/183770872439/i-wish-i-hadnt-part-ii

Link to part 3 “I am confusion”:https://thirteenthspirit.tumblr.com/post/184778393699/i-am-confusion-part-iii

It’s been about a month since the last update to this story. I’ve been through the thick and thin, rose high and fell low. I wish I could say I was over you, but… I’m missing you so much today that I couldn’t be further from that goal.

I continued therapy. Weekly sessions, they helped me detangle the mess in my head. But they didn’t really do much to ease the pain of heartbreak, time is the only course of treatment for that. And time did pass.

Not enough. I kept having regular triggers upon receiving your messages, even if they were only to boast about your most recent “shiny” encounter. And as light-weighted and simple as they were for you, they were monumental for me. They ruined my day. Rekindled the connection I was trying so hard to bury. Part of it was my fault, the withdrawal from not actively contacting him made me check his Instagram profile, which was riddled with references to his boyfriend – a bit masochistic of me, I realize.

The last straw happened at an Ed Sheeran concert. Big event, took place in a stadium here in the city. I went with my roommate, she had tickets. We were sited, waiting for the concert to start, when I saw you post on the Pokémon group a screenshot of the arena, with the caption “Looks like Ed Sheeran turned into a Snorlax!”. My stomach dropped immediately. I also commented I was there, and he immediately came to speak with me via private chat. Obviously, he was there with his boyfriend – and 7 other of said boyfriend’s flamboyant friends. He kept complaining to me how he hated the music and didn’t feel like he was fitting in at all, among the people he was with. So his boyfriend had paid him the ticket and he was complaining, to me, while standing next to him? Real mature. Anyway, it ruined the concert for me. Let’s just say the sad songs were a sob fest for me, for about 10 mins straight.

I realized then that the proximity wasn’t doing any good. I had changed houses, I stopped going to any part of the city where I might encounter him, and yet… the tether was still there. Any sign of him was still enough to send me reeling. So I knew the only way forward would be to do what I was most afraid of – completely cut him off. I had postponed it long enough.

It’s the first advice people give you upon a breakup – sever all ties immediately. But since we didn’t have a relationship per se, I assumed normal rules didn’t apply.

So sever is exactly what I did. I took a knife, went straight to his house and – no, ok. Fine. Only in my mind did I do that, sometimes. I just cried and went to therapy. During a session, he messaged me, by pure chance – my session was taking place during the “Cresselia raid hour” and he wanted to let me know he had caught 3 shinies, asking whether I already had one. My therapist saw, live, the effect a simple message from him had on me. She could read it in my face. All the join and mindfulness completely drained away in .5 seconds. So she pushed me to cut him off. In that moment.

I didn’t want to at first but I myself had realized previously I needed to do exactly that. So I filled myself with courage and texted him “Hum… Could you please not text me anymore?”. His reply was “Huh?”, to which I answered “Thanks. Sorry.”. He then retorted with “Ok. Bye.”. It wasn’t exactly “bye” but it’s an expression in Portuguese akin to that – “Fica bem”. Meaning “stay well” but in a more “Peace out” chilled and dismissed way.

And that was it. That was the last time I spoke with him. It’s been over 2 weeks since then and there has been 0 contact whatsoever – I still see him speaking on the Pokémon group all the time, but I just stopped opening that conversation. Sad that I’ll have to sacrifice losing some good friends just to stay away from him but if that’s what it takes… I just can’t deal with these triggers anymore.

The following day I cried my eyes out, which I still hadn’t done. A necessary step in every breakup (?) I’d wager. People go to therapy over losing friends, or so I’ve been told.

Either way, I don’t know if the realization that I’m the bad guy in his story, the mad one who stopped wanting to be friends overnight and needs to go to therapy over his crippling depressive state, helps me or not. It hurt more then than it does now, so that should be the takeaway. Then again, I was never really that important for him, so losing me didn’t affect him in the slightest, right? So I’m not even worth the label of ‘bad’ or ‘important’ guy in his story. Just a shrug of the shoulders without even a second thought.

So that’s my life now, I guess. I still have my triggers, my moments. I still avoid going to 50% of the city because of him, including my parent’s house… Lucky for me they have been super understanding, and come hang out with me at my place instead. My mother suspects what’s going on but doesn’t know 100%.

The only dark thought is… when does this stop? I’ve done everything I was supposed to and yet there are still days in which I am so lost and hopeless without you. Then again, maybe I would’ve felt the same way with you – your narcissism definitely wouldn’t help me in the slightest.

I took the title of this chapter from something my therapist told me. You see, I had spent the past weekend at my roommate’s parent’s house in the country, which stood upon a rocky cliff. That cliff was a notorious spot of election for suicides. The odd unfortunate soul or two had been known to take their lives upon those rocks, tossing their ID into the garden of the house. And after returning home… I couldn’t stop thinking of the cliff. Couldn’t see the light at the end of the tunnel.

The privilege guilt I felt over that, I mean how could I, a young man with no visible disabilities or hindrances in life, who is only hurting over a stupid love rejection, compare myself to the people who were so desperate that they wound up actually taking their own lives – people with real problems, real issues.

Either way, I couldn’t prevent the thoughts from escalating. My friends made me promise to talk to my therapist about them, which I did. She started keeping a closer eye on me from the on, but her immediate reply was this:

“People don’t really kill themselves over romantic heartbreaks. In most of the cases, it’s about money. The money troubles really take the cake on this one. But love… passes. It doesn’t stand the test of time. So hang in there.”

And hanging in there I (still) am.

João A. (Xanuda)

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myinconnelly1 · 6 years ago

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feeling kinda salty

feel free to ignore this if it’s not your thing, but i saw a post explaining how things worked in a hospital, and it made me salty. This is marked as 18+

So without further ado: What it’s like when your pregnant!

Unless you are tracking your cycle you probably don’t know when you conceived.

You don’t need to have full penetration to get pregnant.

Having an irregular cycle is probably the only reason that you didn’t notice you were late. (As a person who could set a clock to the minute based their cycle) You will probably at least suspect it with in the first 2 months.

There really aren’t any other symptoms until week 7-9 (aka 2-3 months)

Morning sickness can hit at any time. Literally any time of day, and day of the week, through your entire pregnancy.

You will have to pee a lot during the first couple month and toward the end. Usually not too bad in the middle.

you don’t normally start to ‘show’ until 5-6 months.

there is nothing that looks like a baby to see in an ultra sound before 12 weeks really. (just a tadpole)

You won’t hear the heart beat until 12 weeks via handheld Doppler.

That jelly stuff is either cold AF or kinda warm in that way that makes you want to pee yourself.

You might pee yourself. Especially if you are laughing really hard or you sneeze. There are exercises to help with this.

You may develop bruising around your eyes that looks like little speckles after you throw up. This is caused from the strain and lack of oxygen. Its really common.

Cream is not a guarantee that you will not get stretch marks.

Your belly button may not pop out like a timer.

You may not ever really look like your pregnant.

You will be tired as shit

Ultrasounds are not comfortable. there is a lot of pressure no matter what kind you have.

Everyone will start to irritate you.

Then you will cry for hating everyone. And then rage cry because no one gives af about you, only when you are finally gonna have that baby (even when you only 5mos pregnant.)

Your husband/SO may try to do everything that he can to be sympathetic or helpful; he may do nothing. Regardless of which it is, you will at some point be mad at him for what he is doing.

You will be ready for it to be over.

You will probably forget something from your hospital bag.

Having a c-section is not easier.

your water may not break.

you also may not notice that it has broken.

it is more likely that you will go to the hospital several times and not need to be there, than you are to be too late getting there.

there is no paper work to file out while you are trying to have your baby for insurance. normally you have filled it out months in advance.

There will be an IV. (and they hurt like a bitch)

There will be a lot of blood, from all kinds of places.

getting an epidural doesn’t hurt. (for me it was one of the only times i ever felt in control of my contractions.

Contractions hurt like FUCK (when they are being done right and when they are done wrong.)

You will need to drink a lot of water.

If you are have a c-section you will not ingest anything. And this will cause you to feel even more like shit.

if you need a c-section after you’ve started labor, they will make you drink this awful tasting drink (about a shot glass) it neutralizes your stomach acid, in case you vomit during surgery. 50/50 chance it makes you puke.

if you have an epidural you will still have minimal feeling. It’s like that state just after a limb falls asleep and starts to go numb. Kind of buzzy.

The Doctor won’t be there until you need to push. And if you have a midwife, they won’t be there at all unless there is a problem.

An OB will deliver you if you need a c-section.

Anesthesiologists are sweet AF and actually care if you are still in pain.

If you are already numb and need a c-section, they will pick you up and move you from your bed to an operating table. The nurses will tell you that you need to keep your eyes open. This is to keep you from getting motion sickness and projectile vomiting (whistles innocently) seriously don’t even blink.

Pushing a baby out is hard work. and can take a long time. I pushed unsuccessfully for 2 hours with first babe. and then half hour-45 min with second.

Those maternity nurses can be pretty fucking creative. (i played tug a war to try and push correctly)

There are a lot of people that come in and out of your room, between doctors, nurses, nurses in training. Dietitians, insurance workers. And half of them or more will touch you in some uncomfortable fashion.

there is no dignified way to go to the bathroom once you are hooked up to an IV.

Once your baby is born you will need to push more. Then they might need to do some stitch work. Then you will finally be alone for a little while. Maybe an hour. Then you will be moved to another room in another part of the hospital.

if you had a c-section, you will be moved from the Operation theater, to a recovery room. This is for a pretty short time, maybe 20-40 minutes. In which you are alone for a bit. Some times completely alone. (if this is the case, it is the shortest 20 minutes, followed by the longest 15 minutes of your life)

You might not be lactating yet. And therefore breast feeding will be next to impossible, as well as painful.

If you had a c-section, it’s like getting hit by a bus, and you won’t want to do anything for days. Including laying down on a full incline. (it’s like there are no muscles restrictions and all of your insides can just slosh where ever they want.)

You will probably look like hell. Especially if you have any kind of complications.

there will be lots of bleeding.

a nurse will come in an press on your stomach to help get the swelling back to where it should be. (this is possible the most painful thing in the entire process)

The first shower after the baby is born is the most amazing feeling in the world.

#myin rants #having babies #writing it right #stop fucking it up

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remindersofgrace · 6 years ago

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Our Birth Story

Today marks 10 days since our daughter Talitha was born. Our daughter - I’m still getting used to saying that. She came without warning and on her own timing, but I’m beginning to see God’s perfect providence in blessing us with this sweet little girl 5 weeks early. I woke up Saturday morning, September 1st, 2018 at 5:30am without an alarm, unsure of why I felt so wired and unable to fall back asleep (which, if you know me, is a very unusual thing). I was feeling some uncomfortable pressure in my lower abdomen and kept sitting on the toilet for relief, and actually pooped 4 times in 4 hours but had no idea that this could be a sign of early labor. (Is that TMI? Oh well.)

By 10am though, the pain had started moving up my abdomen, and I started to count the contractions. They were sporadic, 30 seconds of pain every 6 min, then 40 second after 4 min, then 3 min, then 8 min - but they were persistent and unlike any Braxton-Hicks contractions I had felt before. I texted Talitha, my friend and doula (we’ll call her Talitha P so you don’t confuse her with our baby), and let her know what was going on, but still didn’t think anything serious was happening until she texted back, “Oh my goodness. Definitely monitor them and keep me posted.” She suggested hopping in the bath to see if that would help the contractions subside - and although it seemed to ease the pain a little, after the bath the contractions started up again every 6 min. We called the triage line at Kaiser and the doctor on the line told me she wasn’t sure it was true labor, but instructed us to come in just to be safe.

We cancelled our lunch plans, haphazardly threw together a hospital bag for me, threw our car seat in the trunk (we still hadn’t figured out how to strap it in yet) and called our mothers during the car ride to let them know that we were headed to the hospital for triage, but that we didn’t think we were going to be there for long. After all, Talitha wasn’t due for another 5 weeks, I had 2 more packed weeks of work to transition out for maternity leave, we had a baby shower scheduled on the 15th, and our house was not close to being habitable for a newborn.

The car ride to the hospital was a bit tougher with some stronger contractions, and we walked into the Kaiser Sunset’s labor and delivery unit to be triaged by a nurse. She strapped the fetal monitors on my abdomen, and sure enough - the contractions were consistently every 6 minutes. The pain was there but manageable, and Talitha’s heart rate was responding well to each contraction. The moment came at around 2:30pm when the doctor came in to check how dilated I was, and our jaws dropped when he told me I was 4 cm dilated, 90% effaced - and I was not going anywhere. Eden and I looked at each other and shared a moment of disappointment that our baby was not going to be born full-term, which we were hoping for since she needed to be big enough and strong enough to have surgery shortly after birth. We called Talitha and let her know that I was being admitted, and this incredible woman did not hesitate to drive 2 hours from Palm Springs on her Labor Day weekend to be there for mine. Best doula ever.

We were transferred into the room that I would deliver in at around 3pm, and I was started on an IV to give me fluids and also to give me a preventative antibiotic since my test for group-B strep had not resulted yet. I was also given a steroid injection to give my premature baby’s lungs a boost, but it would only be effective if I was given a second dose 24 hours later. I was hoping that I would not be laboring for another 24 hours, but wanted to give my baby any fighting chance I could.

Well into labor, I still hadn’t lost my mucous plug or had any bloody show, and my water still hadn’t broken. The toughest part about this labor was that because I was 5 weeks early, my nurse didn’t want me to get out of bed and kept trying to have me delay delivery - she thought it was best that I try to hold off until I could get the second steroid injection in 24 hours, or to even delay delivery 4 more days until our baby was 36 weeks old. I looked at her sideways - I couldn’t imagine going through these contractions for 24 more hours, let alone 4 days, and the thought of it stressed me out! Thankfully by then, Talitha P had arrived at about 5:30pm, and she gave me this reassuring look after the nurse left and said, “Don’t worry, you are having this baby tonight.”

By then, Jabez had dropped off an exercise ball for me (sadly it was not used) and my brother-in-law Ken came to support me and Eden as well. The contractions became stronger and more frequent - every 4 min, every 3 min. I went to the bathroom and sure enough, there was quite a bit of blood in the toilet after I peed, and Talitha P reassured me that it wouldn’t be long before I delivered. She had thankfully met with us just a week before to give us a labor crash course in what to expect with labor and how to breathe through the labor pains. During the pain of contractions, the temptation is to tense up your body but that is the opposite of what your body should do. Instead, what you actually need to do is relax your body as much as possible, and so she instructed me to focus on taking deep breaths and to have my palms face up so that I couldn’t clench down. She also would rub my neck muscles to gently remind me to relax my shoulders when she felt me tensing up. And so I was able to get through my contractions without pain medicine and without any screaming, which is something I always wanted to do but didn’t think that I would be able to do. For me, the pain of my contractions was actually pretty bearable (around 6-7 out of 10) because I knew what to expect and the pain was only really bad for about 30 seconds until I could feel the contraction begin to subside. It could have also just been God’s kindness to me because I have horrible pain tolerance!

At around 7pm, the doctor came in to check my cervix again. He told us he couldn’t feel a cervix, meaning I was fully dilated at 10cm. I had to wait through a few more contractions since the neonatologist team was not quite ready to come in yet, and then it was finally time to start pushing. Talitha P had taught me - deep cleansing breath in and out, then another deep breath, tuck your chin in, grab the bottom of your thighs, and push like you’re pushing out the biggest poop of your life for 10 seconds. Then exhale and repeat until your contraction has finished. For me, I was only able to get 2 rounds of effective pushes each contraction. Though women are usually pretty nervous about the pushing stage, pushing actually felt like a relief because you’re finally getting to do what the contractions are making you want to do. I was told that my pushes were effective, and after about 45 min we started to see her crown. The neonatologist and pediatric surgical team came at the perfect moment when I was pushing out my final pushes. I had a mirror positioned so that I could see her come out.

As her little head finally popped out, it was more painful but not unbearable, and she had not yet made a sound. I remember pleading with God that she would take her first breath even with immature lungs. The doctor delivering Talitha instructed me to pause on pushing so that she could reposition her and ease her out without as much tearing. Once she had her positioned, she instructed me to give some final pushes and I gave it my all, and her little shoulders and the rest of her pudgy body made it through. Then came the glorious cry! They instantly put her on my chest for a brief time of skin to skin. I felt so relieved and couldn’t believe this baby on my breast was Talitha in the flesh, the little being we had waited for so long to meet. Eden cut the cord, and Talitha was whisked over to the exam table to be assessed while I delivered my placenta. She was 6 lbs and 10 oz, which we later found out was due to the amount of fluid trapped in her vagina. They indeed found an imperforate anus (which we had expected) but they also found no vaginal opening. The diagnosis was made that our baby had a cloaca, which was on our doctor’s list of possible diagnoses but not at the top. All babies have a cloaca (a common channel for the urethra, anus, and vagina) in the embryonic stage, but it normally separates into the 3 separate channels during development. Our baby was one out of 25,000 babies to have what is called a persistent cloaca and we would learn in the coming days what that meant for our baby and her life.

Eden and our daughter went to the NICU while I received stitches for a second degree tear (not fun). Meanwhile, the neonatologist was furiously putting in orders and contacting our pediatric team to schedule Talitha to have a colostomy and a vaginostomy for 8am the next morning. I was transferred to the postpartum unit, ate some dinner with Eden, Ken and Talitha P, and we reflected back on the delivery together. Talitha P gave me a tutorial on breast pumping before she headed back for Palm Springs. When it was cleared for us to visit our baby in the NICU, we headed over close to midnight and found our baby. She now was on IV fluids and had a little tube threaded down her throat to suction out any contents in her stomach before surgery. Her nurse was so kind and talked me through a lot of what to expect tomorrow, then gave me ample time to hold her skin to skin and snuggle with her. It was such a precious time that I won’t forget. We finally got to bed that night around 1:40am, and so concluded the day that made Eden and myself parents. As I finally finish typing this, we are a day or two from bringing our baby home. We have seen so much evidence of God’s grace during these past 10 days and are confident that He will continue to care for Talitha and for us. She has had an army of over 100 people praying for her ever since her 13-week ultrasound and I know those prayers are powerful and effective. We had prayed for healing, and although it didn’t come the way we expected, I can see already how God is healing broken areas in Eden and myself, and how He is using Talitha and her sweet little life to proclaim His goodness and faithfulness in the midst of trial and suffering.

If you haven’t already, please read my hubby’s post-birth story and also our specific prayer requests for these upcoming months. Thanks to all who reached out and supported us, I wish I could individually thank you all. God is so good to us through you all!

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friendcave2-blog · 4 years ago

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Fat Freezing Birmingham

vagina tightening machine.

Content

Do I need a Gp referral For Facelift surgical Procedure?

Femiwand

Which locations Can Be treated With Hifu?

What Is Mole, blemish and Also Skin Tag Removal?

Why Are Cars Facelifted?

exactly How Does A Hifu Facial job?

What Can I anticipate throughout My Cryopen treatment?

Because of its distinctively designed transducer system customers typically really feel marginal pain during the treatment. Any type of awkward sensations usually subside quickly adhering to the procedure. Visual appeal Lab is dedicated to guaranteeing your health and wellbeing. During your initial Ultraformer III examination, we examine your medical history with each other to make sure that this treatment is best for you. Nevertheless, outcomes may occupy to 3 months to reveal and they will continue to boost for as much as 7 months post therapy. People might experience skin inflammation for a few days after the session. Some mild swelling, prickling or tenderness might occur temporarily.

Much less typical results consist of slight bruising and also skin level of sensitivity. The dimension of the therapy area and the plan picked influences the period of the HIFU treatment session, which can vary in between 30 and also 90 mins. We will be able to offer you a quote throughout your examination. In the past I've attempted all type of systems to help with my stretch marks as well as decrease as well as tighten my infant tummy after the birth of my youngsters. The only therapy that I have actually seen results with is the Lipofirm Pro!

This entails relocating the handpiece over the location and also supplying pulses of power to accomplish the wanted result. Your therapy may be a little uneasy yet should not be painful and also any type of pain needs to promptly subside instantly after treatment. At your examination, we will certainly take a full case history and also examine your suitability for the treatment. We will then coordinate a customized treatment strategy with you, based upon your problems as well as what you want to achieve from the therapy. Really hardly ever one may experience small inflammation for a couple of hours after the treatment in addition to swelling or prickling in the therapy area for approximately a few weeks. There may likewise be bruising as well as tingling on dealt with areas but this need to solve 2-4 weeks adhering to the treatment. Ultraformer III has actually been referred to as the comfortable alternative to surgery and also Ultherapy.

Do I need a General Practitioner referral For Facelift surgical Procedure?

You may have an MRI check and several examples of prostate cells taken. This will certainly give the physicians a clear image of where the cancer cells remains in the prostate. HIFU can be given to the whole prostate when there may be cancer in more than one area, to make sure that all locations of cancer are treated. reportedly used might additionally have other tests, such as a CT check, MRI scan or bone check, to see if the cancer cells has infected various other components of your body. A constant increase in your PSA degree can be an indicator that the cancer has actually returned. If your cancer does return, your medical professional or registered nurse will chat with you about more treatment options.

Femiwand

The majority of individuals tolerate the treatment well while the energy is being supplied. Discomfort and also discomfort connected with the treatment are momentary and are only experienced during the treatment. A three dimensional option to an invasive facelift, without any cosmetic surgery and no down time. All skin consultations will be done by phone to examine your suitability.

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After my training course and also a bit of Physio I am entirely back on kind. The treatment really aided me obtain my confidence back, and the will to begin training again. Tone, tighten up and solid skin on your confront with this introducing therapy.

Results from trials and also early instances in the first 5 years are very encouraging with lifestyle outcomes far better than the majority of other standard treatment alternatives. The HIFU procedure commonly lasts in between 1-4 hrs, depending upon the size of the prostate, and is either done under basic anaesthesia or an epidural as well as IV sedation.

Which areas Can Be treated With Hifu?

How can you tell if someone had a facelift?

Bald spots in the temple, pulled ear lobes, visible scars that are placed in front rather than inside the ear, wide, cross-hatched appearing scars, and stretched lips are a few other telltale signs of an 'old' facelift.

What Is Mole, growth and Also Skin Tag Removal?

Our reference campaign offer stands whatsoever facilities for any kind of package. Share this page to your close friend and then go into the promo code, "FRIEND30" when reserving your Free consultation. The HIFU treatment is ideal for those individuals that wish to uplift their face, tighten up the skin and total fight indications of aging. Whilst the treatment does not injured, you might experience small pain throughout the procedure, just like a light prickly sensation. Did you understand that you can book your assessment in either of our cosmetic facilities in Nottingham or London? https://jamesmakeup4.tumblr.com/post/633990441038135296/how-to-obtain-a-stronger-vaginal-area-bucks dedicated to supplying a top quality, personal as well as practical service for each and every and also every one of our people, making it as easy as feasible for you to get to our very competent experts. Book in at our Nottingham or London clinic today, we can not wait to see you quickly.

These guys will certainly have routine examinations to keep an eye on the cancer that is not dealt with. Some males that have focal HIFU have just one location of cancer cells in their prostate. Focal HIFU deals with a smaller sized area of the prostate as well as takes one to 2 hrs. It may appropriate for men that have cancer cells that needs treating in just one location of their prostate. You may have a catheter placed in at the start of the treatment to drain pipes urine out of your bladder. A catheter is a thin tube that is passed into your bladder, either through the penis or through the wall of your abdominal area. You will have a basic anaesthetic to ensure that you're asleep during the therapy.

How do you wash your hair after a facelift?

After the dressings are removed, shower and wash your hair. Use warm not hot water (much as you would wash an infant.) Use only baby shampoo. Let the water run through your hair to remove all dried blood and surgical soap.

On the morning of your HIFU treatment, you'll be provided an enema to empty your bowels. You'll also be asked not to consume or consume alcohol for around 6 hrs prior to your HIFU. If you're having focal HIFU, you will normally most likely to a testing appointment initially

You can see the outcomes right away, and the enhancements remain to be seen for as much as nine months as your collagen is renewed.

HIFU is safe, efficient and a great remedy for lifting and tightening the dewlaps, minimizing great lines around your eyes, nose and also mouth, tightening your skin around your jaw and neck line and decreasing hooded, droopy eyelids.

High intensity concentrated ultrasound is often utilized as a treatment for early prostate canceror prostate cancerthat has returned after radiotherapy.

As opposed to surgical procedure, the Ultraformer harnesses ultrasound technology to emit power to the SMAS layer to tighten, lift and plump the skin.

HIFU is newer than some of the other treatments for prostate cancer cells, so we don't referred to as much concerning the risk of side effects or just how well it works in the long term.

Focal therapy utilizing high-intensity concentrated ultrasound for localised prostate cancer.

It is provided as component of a professional test, so it is just offered in some healthcare facilities in the UK.

As a result of this, it's just available in specialist centres in the UK or as part of a scientific trial.

These tests will certainly help your specialist target the area of the prostate that needs to be dealt with. As HIFU is relatively new expertise regarding the long-term advantages as well as effects is enhancing on a daily basis.

I have constantly been fairly athletic, however just recently because of injury I have been not able to educate and also as a result my breast and also Abs have gone a little bumpy. After checking out the facility the therapist informed me that as a result of absence of motion, my blood circulation has slowed down as well as I have created cellulite.

How much does a ponytail facelift cost?

Cost: $8,000–$11,000. The Hair Trick: A DIY ponytail placed just right will yield impressive results too, even if only for an evening.

Transurethral resection of the prostate is an operation to get rid of prostate tissue as well as improve the circulation of urine. This procedure is in some cases utilized before HIFU to lower the risk of some urinary issues after the treatment. Ask your doctor or registered nurse which type of HIFU might be appropriate for you. HIFU could be ideal for you if your cancer is contained inside your prostate. The Material on Our Website does not make up guidance on which you must depend. Expert or specialist advice needs to constantly be looked for before taking any type of activity associating with medical visual treatments.We clear up initiatives to make sure that the Material on Our Website is total, accurate, and also up-to-date.

Why Are Cars Facelifted?

HIFU treatment takes minutes, throughout therapy it prevails to experience some pain as well as a tingling feeling relying on the strength of the ultrasound. This introducing therapy makes use of the most recent cosmetic innovations to aid tone, tighten up as well as strong skin on the face, which helps to lower the appearance of fine lines and creases as well as leave the skin looking invigorated as well as younger. We can estimate the rate for therapy after a first totally free consultationwith you. If the client chooses a body contouring therapy, fat cells are removed by means of lipolysis.

exactly How Does A Hifu Facial job?

Optimum cosmetic outcomes are possible with only one treatment session, the study photos below give an instance of the arise from HIFU treatment. targets fat by making use of high-intensity ultrasound energy causing thermal coagulation to fat cells. The power created penetrates listed below the skin surface and triggers cellular rubbing within cells. As visual medication has progressed, ultrasound has proven to be an outstanding tool for numerous clinical treatments. Total Body Care uses advanced Skin Firm therapy for the face as well as body using High Intensity Concentrated Ultrasound. A typical side effect of ageing is loose, drooping skin, brought on by the exhaustion of collagen as well as elastin in the dermis. Ecological elements such as sunlight damages and cigarette smoking can further reduce levels.

If you have focal HIFU, you may have low-risk cancer cells in one more area of the prostate that is not dealt with deliberately. You will certainly have normal tests to check the cancer that is not treated. These might include PSA tests, MRI scans, as well as prostate biopsies. You might have a few of the adhering to signs and symptoms directly after treatment, or they may create some time later. Talk with your physician or nurse if you have issues with erections or other sexual issues. They can describe your treatment choices and also prepare cost-free therapy on the NHS. Some men have problems getting or maintaining an erection after HIFU.

What is the best face tightening procedure?

If you aren't able to have a basic anaesthetic for health reasons, you may be able to have a spine anaesthetic to ensure that you can't feel anything in your reduced body. With this, you will also be offered some medication to make you drowsy.

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This is since it can harm the blood vessels and also nerves that control erections. For some men this will enhance, but for others this will be a longer-term side effect of HIFU. The list below negative effects can develop soon after your therapy. If you have hormonal agent treatment or a TURP prior to you have HIFU, these can also cause adverse effects. Various other men have one more area of cancer in their prostate that is not dealt with purposefully. This cancer is not treated due to the fact that it is much less likely to spread out (low-risk cancer cells) as well as it might not create any kind of issues.

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kookingtae · 7 years ago

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the equation of love pt. 10 (PREVIEW)

pt. 1 | pt. 2 | pt. 3 | pt. 4 | pt. 5 | pt. 6 | pt. 7 | pt. 8 | pt. 9

→genre: smut | fluff | angst

→a/n: so bc ive taken over a year to update this series (which i am SO sorry about) and bc i love you guys so much… i decided to post a little preview of the finale for you all to read :”))

Running water.

It was such a simple, yet fascinating concept—atoms and molecules coming together to form the only substance on earth that has a natural state in all forms, while having the power to kill in three different ways. Solid, by hypothermia; liquid, by drowning; gas, by suffocation. This substance can take three different forms, yet it’s most commonly a liquid, covering nearly 71% of the world with translucent bodies of water. Oceans, ponds, lakes—though the most enchanting of them all were rivers. They were always moving, crashing beyond rocks and bustling with the flow of the current and gravitational pull of the earth. Rivers were passionate, and strong, and no matter how hard one tried, they couldn’t break the whipping tide that was pushing against them. Nothing could cause the powerful force to falter.

But, like most things, even rivers must come to an end. The current stops flowing, and the waves stop breaking around the jagged rocks, and the powerful force that seemed it would never end dulls to a still, calm lull, as if the river was nothing more than a brief yet raging storm. All the passion, all the fight—all over in a blink of an eye, left to dissipate into the mysteries of the vast ocean.

Staring down at the picture of Yoongi and I kissing on the cell phone screen in front of me was like getting pulled by the current of a river; down, down, down I flowed until there was no river left around me and I was left stranded in the middle of the vast open sea. Yoongi and I were once raging, and passionate, and ready to fight against anyone who tried to tear us down, but now the fight was over. We had been dragged too far, fading into a body of water that was not our own. This was bigger than us.

Yes, like the flow of a river, all things must come to an end.

“That’s it,” Yoongi gritted his teeth, and I felt the dip of the mattress beneath me as he rose to his feet in anger.

“Yoongi,” I called his name in a warning tone, warily standing up from the bed and watching him move around the room. “What are you doing?”

“I’m over it,” he said, hastily throwing the first articles of clothing he could grab from his drawers over his body. “I’m done dealing with all of this, Y/N! I’m going up to the school.”

Despite the flare of determination that sparked in my heart at his words, his rage seeming to radiate off of him and spread onto me, I couldn’t help the trepidation that I was also filled with. Yoongi didn’t have a history of making rational decisions out of anger.

“Don’t you think you should calm down first?” I offered, trying my best to match his pace around the room.

“No!” Yoongi suddenly skidded to a halt in front of me, his eyes wild and crazed. “I’m going to find her and I’m going to fucking kill her!”

I could only stand with a gaping mouth and watch as he stormed out of the room, leaving me with no choice but to pull my old clothes on and chase his stomping foot steps. He grabbed his keys before storming out of the apartment, down the stairs, and outside into the parking lot. I tried to ignore the blindingly bright sunlight as I squinted my eyes and continued after him.

“Follow me up to the school,” Yoongi barked as he hopped into his car.

“Yoongi–” I started, but my consoling voice was cut off by the slam of his door. I frowned, scrambling to unlock my vehicle as his engine roared to life.

The drive to the university was a nerve-wracking one. I kept a watchful eye on Yoongi to make sure he wasn’t speeding or swerving all over the road; they say you’re not supposed to operate a vehicle while you’re upset. Though it would seem my efforts were futile, because he did in fact speed and swerve, and all I could do was frown and try to keep up.

It wasn’t that I wasn’t angered by Professor Lee; I was furious, rage and disgust and frustration all stewing inside of me like a pot of hot water that was ready to boil over. But I just couldn’t help but worry for Yoongi. I had always been the non-confrontational type, always hoping that with a little time things would get better if they were ignored long enough. But it would seem that my method was proven inefficient today, because as much as I had tried to ignore her antics, that wicked woman wouldn’t stop at anything to make sure Yoongi and I were properly dragged through the mud and going down like a ship engulfed in flames. Yet as much as that angered me, I couldn’t bare the thought of the turmoil it was causing Yoongi. I didn’t know when I had started casting my own feelings aside and putting his above—it was a gradual thing rather than one, defining moment—but it was only another factor that proved how much I actually loved this man. And that very thought instilled a fear that shook me to the very bone.

We had a lot more to lose now than just his job and my education. We could be losing us. And that was more important now than it had ever been before.

“Yoongi!” I yelled once I had lessened the distance between us, now dead center on the campus sidewalk. “Yoongi, wait!”

The world stopped spinning for a moment, everything around me fading into the motions of his plush skin, his soft lips exploding with flavor the way a grape would burst onto my tongue when I bit down, its juices spilling over my tastebuds and satisfying my thirst in a way that no water ever could. I didn’t even question it for a second before I was melting into him, quite literally becoming putty in his hands as the rest of the world instantaneously escaped my mind.

It’s funny the way that worked—the way he was able to completely erase everything that had once existed in the blink of an eye, just by his simple touch. Whether it was magic, or I was just that fucking whipped, I didn’t know. But either way, I didn’t possess the power to stop it even if I wanted to.

When Yoongi finally broke away, he was breathing heavily, his breath fanning across my face in cool puffs of air. “I don’t care what anyone thinks anymore,” he spoke onto my lips, his forehead pressing against mine with a firm force. “Let them see. The only thing I care about is you.”

And in that moment, I knew what I had to do.

My lungs were filled with a breath of newfound determination, dazed and driven by Yoongi’s words and embrace. “I love you,” I spoke with conviction, caressing the nape of his neck as if to give him more reassurance. “Let’s go.”

With that I grabbed his hand, holding my head high for the rest of the campus to see as I started up Yoongi’s stride towards the school’s building. He was right beside me, weaving his fingers through mine and giving my hand an extra squeeze as if to say that he was here, that he was proud to let the world know that I was his and he was mine, and that he wasn’t going anywhere.

We were going to take down Professor Lee.

#YOU GUYS ARE THE BEST EVER IM SORRY FOR NOT UPDATING IN FOREVER #AND I KNOW THIS PREVIEW IS NO WHERE NEAR GOOD ENOUGH BUT I FIGURED SOMETHING IS BETTER THAN NOTHING RIGHT???#the equation of love #preview

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cutekookie · 7 years ago

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oh hecking heck it's been a while

an actual angel @kookminau has tagged me in a tag game thing. thank u bby 😇❤️

THE LAST:   1. drink: ribena my baby my smollest child 2. phone call: my mum bc she was tryna work out how to use facetime lmao  3. text message: “i just woke up” classic  4. song you listened to: look here - bangtan 5. time you cried: yesterday after i saw jm and jk in the bon voyage episode hahaha kill me  6. dated someone twice: no thank god 7. kissed someone and regretted it: ye o boi 8. been cheated on: nah 9. lost someone special: who hasn’t 10. been depressed: ye 11. gotten drunk and thrown up: every time cries

LIST 3 FAVOURITE COLOURS:   12-14. gold, red and pink!!!!!!

IN THE LAST YEAR HAVE YOU:   15. made new friends: yeye❤️❤️❤️ 16. fallen out of love: on reflection p sure it was just infatuation but maybe?? 17. laughed until you cried: yeah omg  18. found out someone was talking about you: lmao yes always 19. met someone who changed you: yes!  20. found out who your friends are: hahaha oh boy yes!!! 21. kissed someone on your Facebook list: a few actually Y I K E S

GENERAL:  22. how many of your Facebook friends do you know in real life: most of them!! like 97% hahah  23. do you have any pets: 3 annoying as heck but adorable doggos! 24. do you want to change your name: last name hell yeah 25. what did you do for your last birthday: i got drunk w some cool cats n had ice cream cake quality 26. what time did you wake up: 10am oops 27. what were you doing at midnight last night: i was asleep LMAO but the night before i was reading this rly angsty drarry fic bless 28. name something you can’t wait for: bts to return to aus pls and thank u.. also jikook coming out video lol i h8 myself 29. when was the last time you saw your mom: like 20 mins ago ahah  30. what is one thing you wish you could change in your life: my height :((( and my head to stop being so hecked up lmao 31. what are you listening to right now: nothing actually haha  32. have you ever talked to a person named tom: unfortunately  33. something that is getting on your nerves: a teacher at my school who thinks ive ‘skipped’ school the past few days (side note: NOT MY CHOICE! I HAVE HECKING GASTRO!!!!!)  34. most visited website: tumblr.com/search/jikook (and fb n shit i guess)  35. mole/s:one on my neck and one on my cheek ?? i think??but they tiny so not sure if the class as moles lmao 36. mark/s: some faint scars on my knees and face from operations and also a birthmark on my toe!  37. childhood dream: to be a palleingtologist .. fuck i cant even spell it now. the one where you dig up dinosaurs and shit.  38. hair colour: black kms school wont let me have bright red.. the second ive graduated tho ill be a firetruck again 39. long or short hair: rn its short as but im tryna grow it out  40. do you have a crush on someone: yes ❤️ 41. what do you like about yourself: my lips/teeth?? sounds strange but idk i have kinda nice lips n my teeth are p bright n straight so?? 42. piercings: oh god okay bear w me: four on each earlobe, rook, cartlidge, lip. had a second cartilidge, but it fell out. had a second lip piercing, but it fell out. had a septum but then i didnt like it anymore lmao  43. blood type: no clue tbh  44. nickname: bumblebee/bee  45. relationship status: i have a gf kinda not officially  but p much?? 46. zodiac: capricorn  47. pronouns: she/her   48. favourite tv show: ooo theres a lot. i rly like Shadowhunters and trashy reality stuff tho ;;  49. tattoos: not yet!!!!!!!!!!!!!!  50. right or left handed: right handed  51. surgery: knee, tonsils removed, and lip bc i managed to split it open when i was 2 lmao,, wild 52. piercing: im like at least 99.9% sure this was already a q 53. sport: swimming and dancing are the only ones i like participating in, but tennis is cool to watch!! 55. vacation: just went to the usa which was amazing, but have been to fiji, bali, italy, and usa (2 times now)  56. pair of trainers: i mean the pair of shoes ive owned the longest is a pair of high top red converse lmao come at me joon

MORE GENERAL:  57. eating: chips lmao  58. drinking: nothing  59. i’m about to: probably read smth idk  61. waiting for: bedtime im so tired rip 62. want: be happy and also get a photo with jeon jeongguk before i die 63. get married: well @ government make it legal for gays to marry then maybe i can lmao 64. career: maybe a teacher?? idk 65. hugs or kisses: both !!!! i love affection in all forms 66. lips or eyes: usually eyes  67. shorter or taller: usually taller but my current gf-not-gf is TINY and shes the cutest omg  68. older or younger: doesnt matter just not a big gap lmao  70. nice arms or nice stomach: ???? nice heart  71. sensitive or loud: i mean loud bc same but sensitive bc thats cool too idk?? 72. hook up or relationship: relationship for sure  73. troublemaker or hesitant: hesitant lmao

HAVE YOU EVER:   74. kissed a stranger: yeah, back when i was tryna prove i was a Heterosexual  75. drank hard liquor: every time a massive mistake 76. lost glasses/contact lenses: yes :((( but they always turn up eventually 77. turned someone down: yeah 78. sex on the first date: idk depends on the person?? 79. broken someone’s heart:  yeah 80. had your heart broken: yeppo  81. been arrested: nah im a cry baby and terrified of getting in trouble lol  82. cried when someone died: of course  83. fallen for a friend: certainly crushed on a friend idk bout fallen tho

DO YOU BELIEVE IN:   84. yourself: eh *vague hand gestures*  85. miracles: maybe,,,, idk 86. love at first sight: nah. i believe in infatuation at first site, and great affection or attraction at first site, but not love. 87. santa claus: i want to in my child heart but nah hhaha. believed until i was 12 tho lmao  88. kiss on the first date: if ur both down yeah sure why not 89. angels: park jimin exists, so... but yeah maybe?? idk

OTHER:  90. current best friend’s name: roman n jay god bless 91. eye colour: hazel leaning more on the brown side 92. favourite movie: oh gosh um???? a lot???? few faves are train to busan (killed me), moana, aladdin, mulan, ummmm idk disney and superhero movies and sometimes horrors haha

I TAG: @mindyourfuckinglanguage & @satansgaypornblog p certain jay doesnt even use this any more but fuck it lmao. also @inbts bc u were in my activity also i dont know how else to say hi but by tagging u in a post... so hi!❤️

thank u goodnight as usual feel free to do it if i didnt tag u live ur dreams have fun bye jikook is real

#me #thank u sonia #❤️❤️❤️#personal #i dont remember any of the tags i used to use lmao

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iloveyeri-remade · 8 years ago

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get to know me meme!

tagged by: @augstd @johnnys-wife thank u cuties!! rules: answer these 92 statements and tag 10 people!!

THE LAST:

1. drink: yellow gatorade 2. phone call: my mom called me and asked what i was up to while she was out 3. text message: “YAAA SAME BITCH” (from a friend in a gc) 4. song you listened to: red flavor by my queens red velvet 5. time you cried: i cant remember hsbcjhbdcf probs a few weeks ago

HAVE YOU:

6. dated someone twice: no 7. kissed someone and regretted it: BIG YES LMAO 8. been cheated on: no 9. lost someone special: yeah 10. been depressed: yeah 11. gotten drunk and thrown up: no

LIST 3 FAVORITE COLORS:

12-14: only orange yellow

IN THE LAST YEAR HAVE YOU:

15. made new friends: yes!! 16. fallen out of love: no 17. laughed until you cried: yes omg 18. found out someone was talking about you: yeah 19. met someone who changed you: not really?? 20. found out who your friends are: yes FINALLY...i dropped the shitty ones and am sticking with my good ones 21. kissed someone on your Facebook list: yeah

GENERAL:

22. how many of your Facebook friends do you know in real life: i have like around 350 and i know about 325 of them 23. do you have any pets: a dog a cat and a fish 24. do you want to change your name: idk i wanted to...no one says it right :( i was considering it but i dont think so 25. what did you do for your last birthday: went to a my fave restaurant with my family and then the day after i went to a dessert restaurant with my friends 26. what time did you wake up: 12pm in the summer 27. what were you doing at midnight last night: on tumblr 28. name something you can’t wait for: to go to the movies again!!! i want to rewatch spider-man homecoming 29. when was the last time you saw your mom: like.....10 mins ago shes just downstairs 30. what is one thing you wish you could change in your life: my body 31. what are you listening right now: im watching a movie 32. have you ever talked to a person named Tom: yes 33. something that is getting on your nerves: my family :) they keep arguing 34. most visited Website: tumblr or youtube

LOST QUESTIONS.

35. mole/s: no 36. mark/s: i have like scars and stuff from accidents hdfdfjhjf and a scar on my chin from tobogganing 37. childhood dream: to open a cafe called the kool kaya kafe jhbvjhbfd 38. hair colour: light brown 39. long or short hair: i just cut it to my shoulder! 40. do you have a crush on someone: no. only mark and yeri 41. what do you like about yourself: im funny 42. piercings: 2 ear piercings 43. bloodtype: idk 44. nickname: kayoush 45. relationship status: single 46. zodiac: sagittarius 47. pronouns: she/her 48. favorite TV show: b99, the oa, one day at a time, shameless, terrance house, unbreakable kimmy schmidt 49. tattoos: none 50. right or left hand: right 51. surgery: when i broke my arm in 5th grade they had to reattach the bones 52. hair dyed in different color: not yet 53. sport: i dont play any :/ 55. vacation: just going to my aunts cottage up north 56. pair of trainers: what....does this mean

MORE GENERAL:

57. eating currently: nothing 58. drinking currently: nothing 59. i’m about to: post this then continue watching my movie 61. waiting for: my sisters to come home 62. want: to go eat something im hungry 63. get married: eventually 64. career: idk!! im going to study anthropology and archaeology so something with that eventually

WHICH IS BETTER:

65. hugs or kisses: hugs dfjbhjfdbj i have a traumatic experience with kissing 66. lips or eyes: eyes 67. shorter or taller: doesn't matter 68. older or younger: idk....i’d prefer 2 years older or 1 year younger or same age 70. nice arms or nice stomach: idc 71. sensitive or loud: both 72. hook up or relationship: relationship 73. troublemaker or hesitant: both??

HAVE YOU EVER:

74. kissed a stranger: no 75. drank hard liquor: no 76. lost glasses/contact lenses: no!! i’ll leave them somewhere for awhile but i always know where they are 77. turned someone down: no 78. sex in the first date: no 79. broken someone’s heart: no 80. had your heart broken: no 81. been arrested: no 82. cried when someone died: yes 83. fallen for a friend: ....yes :(

DO YOU BELIEVE IN:

84. yourself: kinda 85. miracles: no 86. love at first sight: no 87. santa claus: no 88. kiss in the first date: idk ive never been on a date hfvjbhfdjhdf 89. angels: no

OTHER:

90. current best friends’ names: jenna and athanasia....my girls! 91. eye color: green + blue 92. favorite movie: SPIDER-MAN: HOMECOMING!!!!!!!!

im tagging: @jongdaekimm @hanichul @reueluv @velvetgfs @1prisms @sunfelts @somiou @1wice @eunwoosgirlfriend @wlwjieun

#long post

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sugakookiessss · 8 years ago

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tagged by @01bri . thank you so much!!!

Rules: Answer these 92 statements and tag 20 people

LAST:

1. Drink: peach green tea from starbucks 2. Phone call: my mom 3. Text message: my friend viviana bc i was telling her about this old lady giving me the stink-eye for blasting celia cruz out the car lol 4. Song you listened to: tequila by g.soul

5. Time you cried: last night over how good haechan looked in cherry bomb (REBLOG IF YOU AGREE LMAO)

HAVE YOU: 6. Dated someone twice: nope, and wouldnt want to. if we broke up we gonna stay broken up lol 7. Kissed someone and regretted it: havent kissed anyone 8. Been cheated on: nope 9. Lost someone special: yes, sadly 10. Been depressed: yup, but i think my depression is well handled now 11. Gotten drunk and thrown up: nah man, im a child of jesus

LIST 3 FAVORITE COLORS: 12-14: maroon/crimson, forest green, & dusty rose

IN THE LAST YEAR HAVE YOU: 15. Made new friends: yes! 16. Fallen out of love: lol, never been in love 17. Laughed until you cried: every damn day lmao 18. Found out someone was talking about you: mhm, and i shut that shit down real quick. dont mess with a cuban/italian lmao 19. Met someone who changed you: my friend caleb 20. Found out who your friends are: yes, and im glad i have. i dont need any more negativity in my life 21. Kissed someone on your Facebook list: nope

GENERAL: 22. How many of your Facebook friends do you know in real life: i think pretty much all of them except for like 5 or so 23. Do you have any pets: i have a cat named sammi and he is the spawn of satan LMFAO 24. Do you want to change your name: i used to when i was little because i thought it was boring, but now i really like and appreciate it 25. What did you do for your last Birthday: i went out with two friends for lunch, and then we blasted suavemente and danced in the best buy parking lot at like 10:30 at night XD 26. What time did you wake up: around 1:30pm. it wouldve been later but my mom said she brought home mcdonalds lol 27. What were you doing at midnight last night: facetiming my friend viviana and crying over how good haechan looked in the cherry bomb mv 28. Name something you can’t wait for: GRADUATION!!!!!!! SENIOR YEAR BITCHES LETS MAKE IT GOOD 29. When was the last time you saw your mom: like 5 mins ago lol

30. What is one thing you wish you could change in your life: bring my friend caleb back 31. What are you listening to right now: myself typing this long ass q&a post lmfao 32. Have you ever talked to a person named Tom: idk probably 33. Something that is getting on your nerves: ignorant and uneducated people like ughhhhhh 34. Most visited websites: probably youtube, my online course website, and buzzfeed bc i love to procrastinate by doing a quiz when i should be doing my classes lol

35. Mole/s: i have like 3 on my neck ( 2 of them are close together so it looks like a vampire bite, i know its dope asf lmao) 36. Mark/s: i have a bunch of beauty marks/freckles all over my body, plus scars on my legs for being a complete idiot as a kid who thought she was fucking superman at the playground XD 37. Childhood dream: to become a marine biologist, or go to hogwarts (idgaf about marine biology anymore, but im still pressed i never got my acceptance letter to hogwarts) 38. Hair color: naturally blonde, but its dyed to a redish-brown now 39. Long or short hair: medium-long hair 40. Do you have a crush on someone: nope, all the boys at my school crusty asf 41. What do you like about yourself: my sense of humor, my sass and wittiness (basically my personality in general), and my eyes 42. Piercings: 2 on each lobe 43. Blood type: idk but i think its AB 44. Nickname: tori and grandpa lol 45. Relationship status: single and an independent woman who dont need no man 46. Zodiac: taurus/gemini cusp 47. Pronouns: she/her 48. Favorite TV Show: rupauls drag race, and impractical jokers

49. Tattoos: none yet, but when i turn 18 next year im getting one for my bday and more down the line

50. Right or left hand: leftie! 51. Surgery: none, thank jisoos 52. Hair dyed in different color: shit my hair has been the whole fucking rainbow lmfao. ive dyed it red, magenta, pastel pink, dark blue, red/brown, and purple.

53. Sport: i used to play volleyball and basketball but i ended up breaking my ankle so its difficult to run around now (also im a lazy piece of shit too lmao) 55. Vacation: i just recently went to savannah, ga & washington d.c to see some family (me and my cousin binge watched the harry potter series the whole time it was lit) 56. Pair of trainers: im guessing we talking about sneakers. the only nice ones i got are my adidas, the rest are like converse and keds lol

MORE GENERAL: 57. Eating: i had sushi for dinner. blessed the fuck up 58. Drinking: peach green tea from starbucks lol 59. I’m about to: finish working on my english project (kill me pls) 61. Waiting for: monsta x first win (wow i love triggering myself) :) 62. Want: PEOPLE TO STOP SLEEPING ON MONSTA X SO THEY CAN GET THEIR FIRST WIN FOR THE LOVE OF ALL THAT IS GOOD IN THE WORLD ASDFGHJKLDKDFK 63. Get married: i dont think i want to get married bc i dont like feeling like im held down. maybe when im on the verge of becoming a crazy cat lady i’ll reconsider lol

64. Career: music producer, psychologist, or private investigator

65. Hugs or kisses: i dont really have a preference but i guess hugs 66. Lips or eyes: EYES! 67. Shorter or taller: i would like someone taller than me idk just bc

68. Older or younger: older, but not by too much. i think the max would be like 5 years older 70. Nice arms or nice stomach: IM A SUCKER FOR SOME NICE ARMS LIKE SDJSDLKNAFGK;FKFd 71. Sensitive or loud: LOUD. i cant have someone too sensitive it would drive me insane. i have a really strong personality, so if you sensitive as shit you’d probably cry just bc i looked at you lmfao 72. Hook up or relationship: relationship 73. Troublemaker or hesitant: probably somewhere in the middle. i dont want someone who is too scared/hesitant to do anything fun, but i dont want someone who will put me in a lot of bad situations. just a little mischievous lol

HAVE YOU EVER: 74. Kissed a Stranger: nope 75. Drank hard liquor: possbily vodka oF COURSE I HAVENT I AM A CHILD OF JESUSSSSSSSS 76. Lost glasses/contact lenses: my grandma freaking threw my glasses in the trashcan when i asked her to hold them while i went to play basketball with my neighbor 77. Turned someone down: many times lmao 78. Sex on the first date: no 79. Broken someone’s heart: possibly idk 80. Had your heart broken: by my biases bc they dont know i exist :’) 81. Been arrested: nah, and lets keep it that way lol 82. Cried when someone died: of course, im not that heartless 83. Fallen for a friend:i dont think i have

DO YOU BELIEVE IN: 84. Yourself: 100% 85. Miracles: no

86. Love at first sight: lmfao no 87. Santa Claus: when i was little 88. Kiss on the first date: depends

OTHER: 90. Current best friend name: ayszha 91. Eye color: hazel 92. Favorite movie:harry potter and the order of the pheonix

NOW, TAG 20 PEOPLE:

@won-markiepooh-woo @joshuahxng-kong @owopinky @echoayszha @puppyoongs @shownu-the-muscles @skittleluver101 @trollintraining @blockbyung @u-r-my-bias @puervy @tahyungs @jinn1e @min-yoongle @ole-dole-peaches @minyoong-ii @spidermalfoy11 @johnnys-hypewoman @sunshine-hoseok @joishua

(pretty much just tagged my mutuals. you dont have to do this if you dont want to, and if i didnt tag you and you would like to do this tag go right ahead!)

#tags #tag game #all about me #all about me tag #me #about me

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fitnesshealthyoga-blog · 6 years ago

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New Post has been published on https://fitnesshealthyoga.com/its-a-fentanyl-crisis-stupid-national-pain-report/

It’s a Fentanyl Crisis, Stupid! – National Pain Report

By Kaatje “Gotcha” van der Gaarden, PA-C, MPAS.

Editor’s Note: This story was originally published on Dec 17, 2018 on Medium Health.

Featured Image: TEDxABQ 2018 “A Working Parachute: spinal cord injuries, ketamine & comedy” which turned into a 9 min stand-up set! Photo credit Allen Winston Photography

In 2012, life was great: I proudly wore a white coat with a stethoscope around my neck and finally felt useful to humanity. Two decades earlier, as a stuntwoman, my parachute did not quite open, and I landed on my sacrum (tailbone) at 70 mph, crushing the sacral nerves. I had lost two inches of my spine, fractured several vertabrae, and would spend a year in ICU, hospitals, and a spinal cord clinic. I was left with traumatic cauda equina syndrome,¹ suffered from residual pain, and was left with a “sitting disability.” For my atrophied lower leg and foot muscles, I used leg braces, a cane or scooter and I sat on a padded office chair. I’ve schlepped pillows and camping mats with me ever since my skydiving accident. Frequently, lying down for a few minutes was the only way to deal with my disability.

Kaatje “Gotcha” van der Gaarden

As a Physician Assistant in primary care, I loved my job and providing a true provider-patient collaboration. I had ample opportunity to prescribe opioid medications. Responsibly, of course. In my toolbox, I had excellent interview skills, the State’s Prescription Monitoring Program (PMP), and a urine test. The PMP would let me know me if patients were doctor or pharmacy shopping, although it couldn’t take into account other states. A urinalysis would tell me if the patient was taking the opioids as prescribed, or diverting, or using other, illegal drugs, or medications that were not prescribed. Heck yeah, I even had my patients sign an Opioid Use Contract.

One patient’s husband worked for the Drug Enforcement Agency (DEA), and he told me one that opioids went for about 70 cents per milligram on the street, in 2012. However, I never assumed someone was gaming the system and tried to keep an open mind. Some patients did want me to refill their emergency room (ER) hydrocodone prescription, for complaints like a mildly strained knee. At that point, I would print out knee exercises instead. I always tried to understand my patients’ emotional and physical health and encouraged exercise and healthy habits (even if most days, I couldn’t prepare food so I ate LAY’S® Limón Potato Chips and gummi worms).

Another patient had just moved from Arizona, with a history of using 30 mg of MS-Contin, a long-acting morphine tablet, three times a day, plus another opioid, Percocet 10 mg instant relief (IR), one tablet every four to six hours for breakthrough pain. The patient was full-time employed, doing fairly intense labor, and was incensed when I wanted evidence of his “bad back.” The patient did not bring any records during his first visit, but he later returned with a lengthy health record — his pain deriving from five back surgeries, three of them revisions for the original surgeries.

I had never heard of “ultra-rapid” or “slow” opioid metabolizers² which affect adequate treatment, and still believed the Center for Disease Control (CDC) had society’s best interest at heart. The opioid crisis seemed far away, and I believed that did not affect my patients, or myself. Mistakenly, I thought there hardly would have been an “opioid epidemic” had medical providers only accompanied any opioid prescription with this warning: “Use your IR (instand relief) opioid medication when you truly have breakthrough pain, a 7–8 or higher, or it will no longer be as effective.”

Perhaps. But complicating matters was that opioid medications did seem to be prescribed for relatively mild to moderate pain, or in situations where acute pain would soon resolve. For example, to my patient with that strained knee, seen in a Colorado ER. In 1991, I’d fractured my lower leg above the ankle, after a car stunt gone awry, and wasn’t prescribed any opioid medication. The ER doc in Florida who applied the hot pink cast, from my toes to my knee, pointed me to a Walgreens to buy Tylenol (acetaminophen) for the simple, uncomplicated fracture.

Although I was in tremendous pain myself from the sky diving accident and crushed sacral nerves, I denied suffering from intractable pain. Yet I was battling worsening neuropathic (nerve) pain, as well as residual musculoskeletal pain from the sacral and vertebral fractures, on a daily basis. I made it through each workday by lying down on the exam table during lunch. Work gave me great happiness, but physically I had no energy left to cook, maintain friendships or even have a hobby.

That year I recall having to do five mandatory continuing medical education credits by the State on “responsible opioid prescribing.” This seemed ludicrous since I always looked at the PMP before going into the exam room. Especially with a patient that was on medications that fell under the Controlled Substances Act.³ As a non-contract employee, I also paid my own DEA license at $780 every three years for the privilege of writing controlled substance prescriptions. I was ticked off with the cost, but also with what I perceived as government encroachment on my medical decision making.

Sure enough, over the years, after the CDC Opioid Guidelines came out (which are voluntary, and not legally binding), I began to realize that there is no true opioid epidemic. There’s an epidemic alright, of people taking opioids with multiple medications and then adding alcohol and other illegal drugs on top. What we most certainly have is an alcohol epidemic, with 88,000 deaths⁴ annually, and this epidemic is starting to effect millennials. I blame those hipster beers with ridiculously high alcohol percentages, as millennials are dying of liver cirrhosis in record-breaking numbers.

Despite the ongoing alcohol epidemic, from 2012 to 2016, using opioid medication became synonymous with being a “drug seeker.” The “opioid crisis” narrative was perpetuated and fueled by mainstream media, whose culpability lies in using labels like “opioid overdose deaths” instead of the more appropriate “mixed drug intoxication.” True opioid deaths (opioid medications alone) range around five thousand deaths annually, according to Josh Bloom, writing for the American Council on Science and Health.⁵ New York City’s medical examiner’s office is unsurpassed when it comes to accurately determining cause of death: in 2016, 71 percent of all drug-related deaths involved heroin and/or fentanyl.⁶

Looking at the numbers, most of the so-called “opioid deaths” seemed to be people who did not take their medication as instructed, if opioids were legally prescribed in the first place. Seriously, because who cooks their Fentanyl patch and injects it? Not chronic pain patients, who need slowly titrated medication to bathe, cook, work, take care of kids, or go to school. Patients were indeed dying from respiratory depression, caused by taking legal or illegal opiates. But how many of those deaths are suicides? If patients with severe pain, on a stable regimen, are denied access, they may turn to suicide, or illegal opioids like heroin, now tainted by illegal fentanyl. That is not an opioid crisis, but another iatrogenic consequence of the “guidelines.” The Law of Unintended Consequences never fails.

How was it that the CDC took advice from an anti-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP)⁸ in constructing the Opioid Guidelines? PROP had lobbied Federal officials and the FDA for years, to change opioid labels. When they were (mostly) rebutted, PROP got involved with the CDC, behind closed doors. The Washington Legal Foundation⁷ notified the CDC in 2015, as in their opinion, the CDC broke the 1972 Federal Advisory Committee Act (FACA) law. Washington Legal Foundation states that a Core Expert Group, advising the CDC, conducted their “research” and “Draft for Opioid Guidelines” in secret, without input from pain experts, pharmocologists, or patient groups.

Dr. Jane Ballantyne (current PROP President) was part of that Core Expert Group and is notorious for her anti-opioid stance. Another Core Expert Group member is PROP executive director, and founder, Dr. Andrew Kolodny, who refers to opiate medication as “heroin” pills and proclaimed that “oxycodone and heroin have indistinguishable effects.”⁹ Yet you oughtn’t compare a 5 mg tablet of oxycodone to IV heroin, without qualifiers on potency. Dr. Kolodny, an addiction expert, doesn’t even distinguish between “plain” heroin, and heroin cut with fentanyl, which is 100 times stronger than morphine. About 80 percent of fatal overdoses are now due to illegal fentanyl. By muddying the issues of opioid dependence, opioid addiction, and heroin use with either false or incomplete statements, PROP also does a disservice to people who are addicted to heroin or illegal fentanyl.

Research has found that 75% of heroin addicts have a mental health illness, and 50% have trauma from (sexual) abuse before age 16, something that gets drowned in Dr. Ballantyne’s simplified narrative of “continuous or increasing doses of opioids [… ] can worsen a person’s ability to function and his or her quality of life. It may also lead to opioid abuse, addiction, or even death.”¹⁰ Like many others, I argue that (illegal) fentanyl, and indirectly, profound loss of hope, is the main driver behind the current “mixed use overdose” deaths.

Dr. Kolodny was Chief Medical Officer of The Phoenix House, an addiction center, at the time he helped draft the CDC Guidelines. PROP also avoids mentioning the Millennium saliva,¹¹ or other DNA tests, to identify how individual patients metabolize opiate medication and that some are “ultrafast” metabolizers. PROP fails to mention opioid blood concentration measurements, no matter how imperfect.¹² However, no one doubts the conflict of interest: PROP Board members are involved with grants from the CDC, addiction centers, medical device companies to develop an opioid tapering mechanism, and even consulted with law firms investigating lawsuits against opiate pharmaceutical companies.

PROP was originally funded by Phoenix House, one of many addiction centers that prescribes buprenorphine. PROP is currently funded by the Steve Rummler HOPE Network,¹³ another anti-opioid group that lists Dr. Ballantyne and Dr. Kolodny on the medical advisory committee. Dr. Kolodny admitted in a 2013 New York Times article titled “Addiction Treatment with a Dark Side” that as a New York City Health official, he lobbied on behalf of the buprenorphine pharmaceutical industry. He was quoted as saying, “We had New York City staff out there acting like drug reps [with $10,000 incentives -KG].”¹⁴

Buprenorphine was the supposed miracle drug after methadone, but its known side effects include serious diversion, addiction, and possibly, lifelong treatment. Dr. Kolodny publicly promoted buprenorphine in various media outlets, despite evidence of buprenorphine overprescribing, pill mills, and overdoses. The true scale is not known, as most ERs and medical examiners do not test for the presence of buprenorphine. The CDC does not track buprenorphine deaths, despite a 2013 study¹⁵ that found a tenfold increase in buprenorphine-related ED visits, according to the Federally funded Substance Abuse and Mental Health Services Administration (SAMHSA). As “bupe” availability increased, so did diversion and overdose deaths.

Interestingly, that Dr. Kolodny promotes the idea that heroin and opioid medications are the same molecular compound. Actually, buprenorphine has a molecular profile¹⁶ that more closely resembles heroin, than hydrocodone. Dr. Kolodny indirectly claims that CDC “Guidelines” are effective, when the truth is that by the time PROP advised the CDC, prescriptions had already tapered off. This is evidenced in his statement as chief medical officer from a Phoenix House Q&A,¹⁷ dated December 2015: “It will take some time, but we’re already beginning to see a plateau in opioid prescribing.” Dr. Kolodny appears to take credit for a trend that had nothing to do with PROP, and he omits the fact that prescriptions are down since 2011, and yet overdoses are up.

Mainstream media occasionally, and accidentally, reveals the truth. CNN¹⁸ in 2018: “Fentanyl-related deaths double in six months; US government takes some action.” Then again, the echo of Dr. Kolodny’s statements, as reported by CNN: “The recent rise in popularity of these synthetics has been called the third wave of the opioid epidemic; the first wave was attributed to the overprescribing of painkillers like oxycodone and hydrocodone and the second to heroin. The drugs are all chemically similar and act on the same receptors in the brain.” Again, not one word about potency.

Few realize that when the CDC issued the Opioid Guidelines in 2016, there was inadequate research done ahead of time to determine the true cause of the rise in opioid-related deaths. There are no long-term studies on the effects of chronic opiate therapy. Very few, if any, pain management experts or pharmacologists were consulted to determine potential impacts on their practice. Neither veterans nor chronic pain patients were given a true opportunity to issue public comments to the CDC or any other Federal authority prior to the implementation of these new prescribing mandates. The CDC ended up targeting one of the most vulnerable groups, patients with intractable pain.

The CDC’s Guidelines also affect patients with cancer and patients who no longer receive cancer treatment because, unfortunately, both groups report similar pain levels. The guidelines allow the use of opioids during cancer treatment, but they are confusing when it comes to equally severe, post-cancer treatment pain. I fear this “opioid” crisis is far from over, and yet, trust me, this will go down as “reefer madness” in another hundred years. It is a manufactured tragedy that does real harm to patients with intractable pain. The “opioid” crisis also hurts human beings who suffer from heroin, opioids or other addictions by siphoning money, goodwill, and energy.

Few people realize that the CDC hired a PR agency to help sell the American people myths on the “opioid epidemic.” The agency, PRR, designed graphics to “educate” primary care providers that “one in four patients on opioids will develop addiction.” Even the National Institute of Health,¹⁹ another federal entity, estimates this to be 5 percent, not 25 percent. Another research team²⁰ concluded in Pain Medicine that opioid therapy for chronic pain patients (note: in absence of prior or current drug abuse) resulted in a 0.19 percent incidence of abuse.

The language used by the media as well as PROP contributes to misunderstanding; using words like addiction, tolerance, dependence, abuse or opioid use disorder as if they mean the same, directs the casual observer to bias. It’s clear that PROP never was an independent, neutral entity advising the CDC, yet they ended up dictating federal policy, based on flawed evidence. Dr. Ballantyne, Dr. Franklin, and Dr. Kolodny in Politico.com²¹ in March 2018: “We agree with Satel that the answer is not to force millions of chronic pain patients to rapidly taper off medications they are now dependent on (Italics mine). But then, neither is the answer to absolve overprescribing for pain.”

I’m not a linguist, but in that essay, PROP uses the word “addiction/addicted” 16 times, and “dependence” twice. The CDC could have ensured that patients with severe to intractable pain (no such distinction is made) would not lose access to their medications. And yet, that is exactly what happened. Stable patients on long-term opioids were tapered against their will, as the CDC “Guidelines” state it is undesirable to titrate above or equal to 90 morphine milligram equivalent²² daily (aka MME/day). But this was meant for opioid-naive patients, not those on long-term opiate therapy. Primary care providers, who were forced to follow these “Guidelines,” either stopped prescribing opioids altogether or forced patients to rapidly taper to below 90 MME.

Dr. Ballantyne is correct in her remarks that it isn’t realistic to expect zero pain levels, especially for acute pain that is expected to resolve quickly, like a sprain or an uncomplicated fracture. But people with severe to intractable pain are condemned to a world of suffering. Recall my patient with the five back surgeries? I wonder about him. He was working full time, on 180 MME a day, but in his mid-fifties, arthritis would worsen soon. My own story did not end well; I ended up with yet another spinal cord lesion, a benign hemangioma at chest level, which causes “central neuropathic pain syndrome.” My old cauda equina syndrome morphed into “severe, chronic adhesive arachnoiditis.” This is an incurable, intractable, progressive neuroinflammatory disorder whose pain is considered on par with having terminal cancer pain. Still, I try to make the best of it, see my essay, On Being Bedbound.

The CDC and PROP came for me: after using opioids exactly as prescribed, and less than 30 MME daily, my primary care clinic was forced to stop my opioid prescription, and that of all patients. I was not accepted in any pain management clinic, in an urban area of almost one million. Pain clinics here no longer provide “medical management,” yet perform epidural steroid injections ($3000 a pop), which may have contributed to, or worsened my adhesive arachnoiditis syndrome. I’m lucky to live in an urban area, where the academic hospital’s pain team took over my prescription.

But what about elderly and impoverished patients, or those in rural areas? PROP and the CDC claim primary care providers “overprescribe” and are responsible for most of the opioid prescriptions. But they fail to publicly acknowledge that pain management clinics no longer accept patients. This epidemic of undertreated patients will become known as one of the cruelest moves by a Federal agency on an already compromised population. I do feel for teenagers and adults who become addicted. Yet there ought to be a different, more sensible approach towards legitimate, chronic pain patients who need opioid medications, as well as people who develop a substance use disorder, who deserve our help and sympathy.

It is a conundrum of extraordinary proportions. At a time when managed care and Electronic Health Records dictate the length and quality of an office visit, there is less and less time to sit down and connect with a patient. Not just with chronic pain patients. Medicine and society would benefit greatly from the extra time clinicians deserve, to encourage exercise, eat healthier, lose weight, stop smoking and assess if a patient needs other support, like therapy.

In my opinion, it is loneliness, the feeling of not being connected to humanity in a meaningful way, combined with economic hardship, that leads to unhealthy lifestyle choices, as witnessed by the Rustbelt being hit hardest. Research shows that rats who were offered spring water or water laced with heroin, choose heroin. When those same rats were given ample toys, space, and other rats to play and have sex with, they did not choose the heroin laced water. That’s right, happy rats don’t need no heroin!

It cannot be denied that in previous decades, pain was both undertreated, and opioid medications prescribed for relatively minor, self-resolving aches and pains. Forget for a moment, the narrative that places blame on overprescribing, the opioid manufacturers, or the pharmaceutical distributors that, for example, flooded impoverished communities like those in West Virginia.²³ Forget all that, and focus on what is going on. Ultimately, patients with intractable pain pay the price of ignorance by scientists, journalists, politicians, and laypeople alike.

For this humanitarian crisis, there are no perfect answers. For example, as Red Lawhern, Ph.D. and prominent pain advocate²⁴ recently communicated with me (12/3/2018): “there is promise in genetic testing but hasn’t yet been fully reduced to routine practice and may not be covered by insurance.” Luckily my DNA testing was covered, on the condition it tested for depression. I also discovered that ketamine infusions help me most, but will leave that topic for my upcoming book, The Queen of Ketamine. Sadly, amidst the opioid paranoia, non-invasive alternatives like ketamine infusions aren’t mentioned for neuropathic or intractable backpain, which often has a neuropathic component. Research also shows that adding an anti-seizure medication to an opiate mediation provides better neuropathic pain contral, with less morphine²⁵.

In the end, I don’t think Tai Chi, Tylenol and Cognitive Behavioral Therapy is going to cut it for meningeal inflammation or other (neuropathic) pain syndromes. I believe the tide is turning. It will take time, and in that time, patients with intractable pain will choose to end their lives. But we are not alone, and it helps to know that courageous voices, notably the Alliance for Treatment of Intractable Pain, are speaking up for us. The print and online magazine Reason²⁶ has long been a voice of, well, reason. As Red Lawhern stated in a must-listen November 2018 radio interview,²⁷ “We must address underemployment, socioeconomic despair and hopelessness which are a vector for addiction. And end the War on Pain patients.”

Love, Kaatje

Kaatje Gotcha, model and stuntwoman-turned-Physician Assistant, found comedy, writing and advocacy after developing Adhesive Arachnoiditis. This spinal cord disease causes intractable neuropathic pain and leaves her mostly bedridden. Prior to that diagnosis, she’d survived a nighttime skydiving accident, landing at 70 mph. This caused Cauda Equina Syndrome; a subsequent lumbar puncture and epidural steroidal injections may have exacerbated her previous injuries.

Kaatje’s courageous spirit led to writing “The Queen of Ketamine,” available on Kindle in February. This is a comedic yet pragmatic memoir on adhesive arachnoiditis, the opioid “epidemic,” neuropathic pain, dating with a disability, while offering hope and practical advice. Kaatje’s 2018 TEDx talk and book publication will be posted on her Facebook page, at www.kaatjegotcha.com and Instagram @kaatjegotchacomedy. Find her essays on Medium, and follow her on twitter.

Cauda Equina Syndrome https://emedicine.medscape.com/article/1148690-overview

Opioid Metabolism https://www.medscape.com/viewarticle/771480

Controlled Substance Act https://www.dea.gov/controlled-substances-act

Alcohol Epidemic https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

Opioid Epidemic Deception https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Overdose Deaths by Heroin/Fentanyl 71percent https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief89.pdf

Washington Legal Foundation and PROP https://www.forbes.com/sites/wlf/2015/12/15/cdc-bows-to-demands-for-transparency-and-public-input-on-draft-opioid-prescribing-guidelines/#c82eda135bc3

Physicians for Responsible Opioid Prescribing http://www.supportprop.org/

Dr Kolodny refers to “Heroin” Pills https://www.healthline.com/health-news/secondary-drug-industry-booming-amid-opioid-epidemic#2

Dr Ballantyne’s Narrative https://www.statnews.com/2015/11/30/chronic-pain-intensity-scale/

Millennium Opioid Metabolite DNA Test https://www.millenniumhealth.com/services/test-offerings/

Opioid Serum Measurements http://paindr.com/serum-opioid-monitoring-wheres-the-evidence/

Medical Advisory Committee https://steverummlerhopenetwork.org/our-team/

NYT: Addiction Treatment with a Dark Side https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html

Sharp Rise in Buprenorphine ER Visits https://www.samhsa.gov/data/sites/default/files/DAWN106/DAWN106/sr106-buprenorphine.htm

Heroin and Buprenorphine Molecular Profile http://paindr.com/heroin-hydrocodone-buprenorphine-prop-aganda/#comment-334500]

Q&A with Dr. Kolodny, Phoenix House https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

Fentanyl, as Reported by CNN https://www.cnn.com/2018/07/12/health/fentanyl-opioid-deaths/index.html

NIH Estimates Pain Patient “Addiction” 5 Percent https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg9.html

Pain Patient “Opioid Use Disorder” without Risk Factors 0.19 percent https://academic.oup.com/painmedicine/article/9/4/444/1824073

Rebuttal by Dr. Kolodny and Dr. Ballantyne https://www.politico.com/magazine/story/2018/03/13/opioid-overprescribing-is-not-a-myth-217338

Morphine Equivalent Dosing https://www.wolterskluwercdi.com/sites/default/files/documents/ebooks/morphine-equivalent-dosing-ebook.pdf?v3

https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-poured-m-painkillers-into-wv-amid-rise-of/article_99026dad-8ed5-5075-90fa-adb906a36214.html

Red Lawhern, PhD and nationally known Pain Patient Advocate http://face-facts.org/lawhern/

Combining epilepsy drug, morphine can result in less pain, lower opioid dose. https://www.sciencedaily.com/releases/2014/09/140915153613.htm

Jacob Sullum, Reason journalist and syndicated writer https://reason.com/archives/2018/03/08/americas-war-on-pain-pills-is#comment

“Unleashed” Matt Connarton Interviews Red Lawhern 11/28/18 https://www.spreaker.com/user/ipmnation/matt-connarton-unleashed-11-28-18

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askdurianrider · 8 years ago

Note

YO response to bonnyrebeccas tumblr about rt4 & your advice??

1. Im glad that Bonny answers some questions but it doesnt look like her energy is that good because she only answers a handful of questions per week, uploads every now and then and just seems to sit around watching repeats of The Lion King. When she was carbing up she was traveling around, doing more content, got her book out and was HEAPS fitter than she is today.

2. I base my advice on results. Im performance focused. If someone claims they feel better or worse then we look at what performances they did on certain diets/mindsets and then check them today or vice versa. I was talking to Bonny the other day about certain things. It was a long conversation but I didnt ask these questions. Maybe she can elaborate more? I know when I added in more daily fat over 100g that my legs felt really ‘blocked’ on the bike the next day and trying to hit 400w for 5 mins just felt impossible. I also felt more attraction to stimulants like caffeine etc. Like a daily attraction just to do everyday stuff that doesnt even require stimulants! xD

3. Bonny didnt give us any specific cal, carb or fat intakes so it is a bit confusing to the viewer what exactly is different? Was it more cals, more fat grams and less cals or eating at different times of the day and how are we measuring performance gains or losses?

4. Ive been coaching friends on fitness since 1996. Started as a PT in the gym back in 1999. I worked in sports footwear and cycling industry for many years. FADS come and go and industry makes xyz claim BUT Ive learned to sniff out what real results are and what is just fake. Nike claiming their shoes are faster when we know they are being worn by doped athletes just is bullshit. Put those shoes on the average punter and there is zero objective performance increase lol.

5. Give me anyone and I will turn them into their fittest self. Tori is fitter now after just a few months of playing around on the bike than when she was at the sports institute for rowing and guided by professional state coaches. Granted she lives with me so I can monitor her biological read out every hour of the day and adjust diet and training accordingly but you get the picture - Im not bound by institution or government ‘guidelines’. I have freedom to experiment and show people the results. Some people like to pretend that Im ‘fixed and bound’ to my own guide lines but Im not. Ive eaten so much vegan junk food on camera, experimented with steroids etc and poured 300g of sugar onto a 500g packet of kellogs sustain cereal to show people ‘how it affected my blood values in a negative way’ (it didnt and I had one of the strongest rides of my life the next day)

6. I know so many crew who claim to eat one way but eat another way because they are scared of losing customers. I know so many people who still have raging eating disorders and they hide it under ‘allergies’ etc. (Just to be clear Im NOT saying FL or Bonny had ED, in my honest opinion they don’t and living with FL I can honestly say she does eat a lot but when snacking on fatty stuff, she will limit it heavily but try a small amount).

7. Many people say some of the skinny girls on youtube etc have ED and whilst that may be true for some, it isnt true for the people that I promote. As soon as I hear wind of someone starving, Im all over them and making sure Im not promoting their bad example. Fuck man, life is hard enough without trying to get thru the day glucose exhausted and undercarbed AF.

8. I could get Bonny so fucking fit and toned. Bonny hasnt coached anyone to incredible results. I mean she could if she used my program and so could FL but neither girls do coaching and if they do, they are only parroting my template and Im not going to sue them for that haha. Im SO happy people spreading the high carb vegan word man! I mean Bonny going to give a refund for all those people who bought her high carb book? Stephanie? Freelee? Don’t think so bro.

9. People change, beliefs change. Human physiology laws dont though. Give me ANYONE and I can have them earning good money on social media, have them the fittest they have ever been (drug free) and have them more relaxed and confident about themselves and life than they ever thought was possible. Also they will NEVER have to worry about getting fat ever again!

10. To be objective critiques people need to read my 2 ebooks. Some say I recommend this or that but what I rate is in text and in my 2 ebooks. I recommend a LIFESTYLE based on quality sweet fruit IF you can get it. Supplement those cals each day with refined sugars and processed starches like rice, wheat, quinoa, corn, potatoes, yams etc. I say processed because when you cook something is is NOT a whole food! A whole food is an apple. You can drink more apples than you can eat a raw one. You can eat more cooked rice than raw rice. You can eat an INSANE amount of yams, sweet potatoes, corn if it is cooked vs raw aka you will GET WAY MORE CARBS SO YOU CAN GET LIFE FUCKING DONE! (Where is the discussion about training? Like why are people driving cars in Sydney when it is faster to just ride down the road vs store body fat, pollute the earth by sitting in a car that kill children, pets and wildlife every day?)

For those obsessed with just diet diet diet the TRUE WHOLE food DIEt is raw fruit. Just pick up a peach and eat it. That is a whole food!. (Whole food is NOT cooked food lol!)

A diet high in processed foods is essentially what I recommend.

Cooked starches aka rice of any kind, pasta.

Fruit smoothies.

Refined sugars aka dried fruit, cane sugar, fructose syrup, rice cakes etc.

Processed fats like tofu, oil, nut butters etc are good if you are getting too skinny or you have no heart disease risk. I eat them when Im looking to gain a bit of fat or not drop weight too fast because Im riding my bike more than sitting my undercarbed ass in a car. #irony

Bottom line I DONT take performance advice from peeps that can’t even post a tumblr question once a day or upload a basic youtube video once a day yet their profession is social media.

I DONT take performance advice from peeps that wouldnt put a fat person in their instagram shot yet would get dropped by a fat person up a hill on a bike.

People can critique my lifestyle advice (I dont do diets man, it is LIFESTYLE I teach) but fuck, at least so us some epic shit or epic transformations of people you have coached. Im running a 6 week festival this year in Thailand essentially on my own. You think Im gonna do that eating a mouse sized acai bowl I just paid $40 for from some hipster cafe in Bondi where you could drop 100$ on the ground and nobody would notice because they are too busy looking at their phones, their reflections in the window or at other hipsters hair cuts and analyzing the bondi sands tans. 😂

To be continued….

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juniperpublishersanesthesia · 5 years ago

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Thoughts on Pain Management, Postoperative Nausea and Vomiting (PONV) & Brain Fog-Juniper Publishers

Introduction

Persistent anesthesia problems may be summarized as over- and under-medication, pain management, and postoperative nausea and vomiting (PONV).

Over- &Under-Medication

Prior to the 1996 FDA approval of a direct cortical responsemonitor (DCRM), determination of anesthetic dose relied on body weight, medical & physical assessment (i.e. ASA status), and heart rate (HR) and blood pressure (BP) changes, especially thesevital signs changes occurring with initial incision.

The cerebral cortexis the target of anesthetics. The adult brain weighs approximately 3-4 pounds and doesn't vary substantially with body weight.Average body weight doses based on the '70 kg' patient will likely over or under-medicate many patients. ASA status is also an unlikely guide to individual cortical responses to body weight based drug doses.

Pharmacokinetics (PK) and pharmacodynamics (PD) as well as target controlled infusion (TCI) are alternative, yet indirect, measures of cortical response by way of predicting anesthetic blood levels. These approaches would be acceptable if blood levels, not the cortex, were the anesthetics' target.

Vital signs (i.e. HR and BP) are brain stem functions. The American Society of Anesthesiologists’ (ASA) awareness with recall study showed that half of patients who experienced awareness had no change in either HR or BP with which to alert their anesthesiologist [1]. This finding was not an especially surprising since consciousness, memory and pain perception are cortical, not brain stem, functions.

Under-medication is estimated to occur in only 0.1% of patients and may result in PTSD in them. Unpleasant an experience as awareness with recall can be, there are no documented cases of death from anesthesia awareness. Many of the remaining 99.9% of patients may be subjected to routine over-medication ( Figure 1).

Not only does one American patient every day perish (mortality) from anesthesia over-medication but also 16M of the 40M patients (40%) every year emerge with 'brain fog' (morbidity) [2]. Brain fog may be defined as delayed anesthetic emergence, but also can include postoperative cognitive dysfunction (POCD) or even delirium [3-5].

Postop brain fog creates additional morbidity while adding substantial additional costs to the health care system caring for patients who cannot be quickly processed and discharged from the system. Additionally, patients must endure the long-term consequences of their anesthesiologists’ short term care.

The DCRM has been validated in over 3,500 published studies and can be found in 75% of US hospitals. The question remains 'why is directly measuring the organ being medicated with a DCRM monitor only routinely done 25% of the time?’

Part of the answer may lie in the manner in this monitor was originally configured. On a unit-less scale of 0-100, the lower the number, the more sedated the patient. This number is a derived, not directly measured, value. The 15-30-second delay from real time places the anesthesiologist in the unfavorable position of catching up to patient needs instead of being able to anticipate them. This creates a situation like trying to drive one's car with only the rearview mirror's information, not especially safe or useful ( Figure 2).

The first anesthesia textbook with a DCRM monitor on its cover also displayed the electromyogram (EMG) of the frontalis muscle (akin to the EKG of the cardiac muscle) in the picture ( Figure 3). The text described the utility of this real-time signal; i.e. EMG spikes signal incipient arousal and the need to proactively increase sedation to return the EMG to baseline [6]. All that is needed to display the EMG is to use the existing software to select and save it as the secondary trend.

Most patients achieve propofol sedation adequate enough to prevent awareness and recall at 60<BIS<75 (with baseline EMG) level of with 25-50 mcg-1 .kg'1 .min. Over 18-years’ experience titrating propofol with DCRM, variation of as little as 2.5 mcg-1 .kg-1 .min and as much as 200mcg-1 .kg-1 .min has been observed to achieve the same level of amnesia and sedation. ‘Apples’ to ‘apples’ comparisons between patients, despite the nearly hundred-fold observed variation in propofol requirements to achieve, become more meaningful when using numerically based definitions of levels of consciousness achieved [7].

Postoperative brain fog likely is a multi-factorial problem. Until universal DCRM monitoring becomes a standard of care, it will not be possible to clarify the role routine over-medication plays [8]. It is unlikely beneficial for elderly patients to routinely administer 30% more than what is needed to achieve 60<BIS75. Common sense is uncommon ( Figure 4) - Voltaire.

Pain Management

Most people know it does no good to close the barn door after the horses have escaped. But too many anesthesiologists still need to be convinced that it’s futile to try to prevent postop pain by allowing surgeons to cut without first blocking the midbrain N-methyl, D-aspartate (NMDA) receptors [9,10].

Local anesthetic skin injection or incision is an extremely potent signal to the brain that the "world of danger" has invaded the "protected world of self." The sedated brain can’t differentiate between the mugger’s knife and the surgeon’s scalpel (or trocar). While there are certainly other internal pain receptors, no signal is more determinant of post-operative pain than of skin incision (or skin injection). An unprotected incision sets off the major cortical alarmsthat initiate the wind-up phenomenon.

Surgery is a painful experience.Most anesthesiologistsbelieve acardinal function is the prevention of pain during surgery. From 1975 through 1993, this author had never once considered why there was a need for postop opioid rescue for many, if not most, patients. In 1992, a clinical trial began using 50 mg IV ketamine, 2-3 minutes prior to stimulation AFTER propofol hypnosis to dissociate patients for pre-incisional local anesthesia injection [11,12].

When propofol is incrementally titrated ketamine hallucinations are eliminated [13]. For elective surgery, customary propofol increments are 50 mcg-1. kg repeated either to loss of lid reflex/loss of verbal response or to 60<BIS<75 with baseline EMG. This DCRM level is usually attained within 2-3 minutes. Starting with such an apparently homeopathic propofol dose quickly allows the anesthesiologist to determine an extremely sensitive patient and avoid prolonged emergence and, likely, less brain fog.

The benefit of incremental induction is creating a stable CNS level of propofol to protect from ketamine side effects, preservation of spontaneous ventilation, maintenance of SpO2, and not creating the difficult airway [14]. Incremental propofol induction most commonly preserves the tone in the masseter, genioglossus and orbicularis oris muscles, maintaining a patent airway. Absent a propofolbolus induction, baseline blood pressureis also maintained.

After observing the first 50 cases emerge without opioid rescue, it was reasonable to concludethe principle reason patients have pain after surgery is that they've had pain during surgery. The lack of opioid rescue continued over the next 1,214 patients [15] and through to the present day of more than a total 6,000 patients.

Dissociation, or immobility to noxious stimulation, results from mid-brain NMDA blockadelmmobility (i.e. dissociation) has beenconsistently observed in 100-pound female patients and 250-pound male patients with the same 50 mg ketamine dose.

Why does the effective dissociative dose of ketamine not appear to be related to body weight? The adult brain weighs approximately 3-4 pounds and doesn’t vary with body weight. The midbrain is a very small part of the adult brain, and the NMDA receptors are a very small part of the midbrain. Pre-stimulation NMDA block denies the cortex the knowledge of the intrusion of the outside world of danger.

Cognitive dissonance generated by thelack (or dramatically) reduced opioid rescue with pre-stimulation ketamine dose is so great that many, if not most, anesthesiologists will need to observe 10-20 cases to believe them. However, the PACU RNs will notice more quickly. Surgeons and patients' family members will be as impressed as the recovery personnel.Once the patient is protected as described above, the non-opioid, 50mg ketamine ‘miracle’ is achievable with propofol sedation, regional analgesia/propofol sedation, and general inhalational anesthesia ( Figure 5).

Postoperative Nausea & Vomiting (PONV)

Much has been written about postoperative nausea and vomiting (PONV). In 1996, Apfel identified the four most predictive PONV factors; namely, non-smoking, females, history of PONV, planned use of postoperative opioids [16]. Apfel subsequently referenced Friedberg's 1999 study [15] in his PONV chapter [17,18].

Apfel's PONV chapter is number 86 of 89 chapters in Millers' Anesthesia. While patients do not die from PONV, they only wish they were dead. Greater importance to PONV needs to be heeded by our profession as patient satisfaction now plays a role in government and other third party reimbursement.

The data for this five-year review documenting a 0.6% PONV rate (i.e. 7 of 1,264 patients) were collected by 1997 but not published until 1999 [15]. These patients turned out to be an Apfel-defined high PONV risk patient population that received no anti-emetics! No intra-operative opioids or inhalational ('stinky gases') agent were used [19]. Postoperative opioids were routinely prescribed but rarely used.

Analgesia was provided with adequate local analgesia. Spontaneous ventilation was preserved using only a single respiratory depressant, propofol, and scrupulously avoiding intra-operative opioids. no patients received neuromuscular blocking agents. This left the possibility of patient movement.

Patient movement under sedation is usually the cause for great stress on all involved with the surgery, especially the surgeon who may have pre-operatively injected the operative field with syringes of lidocaine and epinephrine. Observing vasoconstriction, the surgeon (incorrectly) surmises adequate analgesia is present and clamors for more sedation.

The anesthesiologist usually responds with a request for additional analgesia. Tempers rise leading to the inappropriate addition of opioids, benzodiazepines etc. or worse, the abandonment of sedation in favor of general anesthesia (GA) with muscle relaxants. None of these maneuvers treat the movement most accurately.

The presence or absence of an EMG spike on the DCRM enables a dispassionate discussion of what the patient most accurately (and minimally) needs to return the patient to the desired motionless condition. In the pre-DCRM era, all patient movement was treated as if it could be awareness and recall. As seen with the headless chicken, a brain is not necessary to generate movement ( Figure 6).

There exists no spinal reflex that can stimulate the EMG of the forehead frontalis muscle. Patient movement without an EMG spike can only be generated by sub-cortical stimulation. This Surgeon's Golden Rules ( Table 1) needs the anesthesiologist’s time preoperatively with the surgeon to assure success without increasing the known risks of GA. This author believes it is very difficult to accept GA risks for patients having surgery without medical indication; i.e. elective cosmetic surgery. A more enlightened approach is possible using the absence of the EMG spike with patient movement to refute the notion that the patient is 'too light' ( Figure 7) ( Table 1).

Conclusion

When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science.

William Thompson, knighted Lord Kelvin.

Popular lectures and addresses 1891-1894

Less is more. - Mies van Der Rohe

Without direct cortical measurement of anesthetic effect, neither science nor minimally trespassing on patients’ physiology will occur. Predictably, problems like over and under-medication, postoperative pain management and PONV will continue to plague anesthesiologists and their patients while incurring avoidable costs. Propofol measurement to 60<BIS<75 with baseline EMG obviates the perceived need of the commonly used 2 mg midazolam premedication. Eliminating midazolam also eliminates prolonged emergence in sensitive and/or elderly patients.

Direct cortical response measurement enables anesthesiologists to treat patient requirements as the individuals they are as opposed to the 80% of patients in the middle of the bell curve. Doing so eliminates outliers, transforms every patients’ ‘mystery’ into an ‘open book test,’ and creates the basis for more humane, cost effective anesthesia care.

Over twenty-five years and in more than 6,000 patients, there has not been a single hospital admission for brain fog, postoperative pain management or PONV. Friedberg’s Triad does indeed appear to answer anesthesia’s persistent problems.

Acknowledgment

Dr. Friedberg is the president and founder of the nonprofit Goldilocks Foundation. Neither he, nor the foundation, receives financial support from brain monitor makers. Dr. Barry Friedberg has been interviewed extensively about anesthesia and propofol by FOX, CNN, True TV, and People Magazine during the MichaelJackson murder trial. A board-certified anesthesiologist for 39 years, Dr. Friedberg developed propofol ketamine (PK) anesthesia in 1992 and made PKnumerically reproducible with the addition of the anesthesia brain monitor (aka Goldilocks anesthesia) in 1998. He has been published and cited inseveral medical journals and textbooks and was honored with a U.S. Congressional award for applying his methods on wounded soldiers in Afghanistan and Iraq.

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journalmaterialscience-blog · 5 years ago

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The Effect of Erythropoietin on Oviductal Congestion during Ischemia Reperfusion Injury in Rats Abstract Introduction: This experimental study examined the effect of erythropoietin on a rat model and particularly in an oviductal ischemia reperfusion (IR) protocol. The effects of that molecule were studied pathologically using mean oviductal congestion (OC) lesions. Materials and methods: 40 rats of mean weight 247.7g were used in the study. OC lesions were evaluated at 60 min (groups A and C) and at 120min (groups B and D) of reperfusion. Erythropoietin was administered only in groups C and D. Results: Epo administration significantly decreased the OC scores by 0.3 without lesions [-0.6200848 - 0.0200848] (p= 0.0496). Reperfusion kept non-significantly increased the OC scores by 0.25 without lesions [-0.4759001 - 0.1759001] (P=0.2831). Together, the Epo administration and reperfusion time non significantly decreased the OC scores by 0.1090909 without lesions [-0.3078424 - 0.0896606] (p=0.2735). Conclusion: Epo administration significantly decreased the OC score lesions in oviducts, however, within the same grade class. A longer study time or a higher Epo dose may reveal more significant results. Keywords: Ischemia; Erythropoietin; Oviductal congestion; Reperfusion Go to Introduction Erythropoietin (Epo) is generally one of the more well studied growth factors. Epo implicates over 29001 known biomedical studies at present. 3.42% at least of these studies concern tissue ischemia-reperfusion (IR) experiments. Certainly, important progress has been made concerning the Epo usage in reversing the IR kind of transient or permanent injuries including adjacent organs and certainly patients' health. Nevertheless, satisfactory answers have not been provided yet to basic questions, as, its action velocity, the administration timing and the dosage. The concept is to forward the knowledge away from the original action of Epo in stem blood cells recovery. However, just few related reports were found, not covering completely more specific matters. A numeric evaluation of the Epo efficacy was yielded by a meta-analysis of 31 published seric variables, based on the same experimental setting, at the same endpoints (Table 1). The special aim of this experimental work was to study the effect of Epo on a rat model and mainly in an oviductal IR protocol. The effect of Epo molecule was tested by evaluating the mean oviductal congestion (OC) lesions. Go to Materials and methods Animal preparation This experimental study was licensed by Veterinary Address of East Attiki Prefecture under 3693/12-11-2010 & 14/10-12012 decisions. All consumables, equipment and substances, were a courtesy of Experimental Research Centre of ELPEN Pharmaceuticals Co. Inc. S.A. at Pikermi, Attiki. Appropriate humanistic care was adopted for Albino female Wistar rats. Normal housing in laboratory 7 days before the experiment included ad libitum diet. Post-experimental euthanasia did not permit awakening and preservation of the rodents. They were randomly delivered to four experimental groups by 10 animals in each one. Ischemia for 45min followed by reperfusion for 60min (group A). Ischemia for 45min followed by reperfusion for 120min (group B). Ischemia for 45min followed by immediate Epo intravenous (IV) administration and reperfusion for 60min (group C). Ischemia for 45min followed by immediate Epo IV administration and reperfusion for 120min (group D). The molecule Epo dosage was 10mg/Kg body weight of animals. Prenarcosis of animals proceeded of nonstop intra-experimental general anesthesia, oxygen supply, electrocardiogram and acidometry [1-6]. The protocol of IR was followed. Ischemia was caused by laparotomic forceps clamping inferior aorta over renal arteries for 45min. The clamp removal restored the inferior aorta patency and reperfusion. The molecules were administered at the time of reperfusion, through catheterized inferior vena cava. The OC evaluations were performed at 60min of reperfusion (for groups A and C) and at 120min of reperfusion (for groups B and D). The mean weight of the forty (40) female Wistar albino rats used was 247.7g [Standard Deviation (SD): 34.99172g], with min weight ≥165g and max weight <320g. Rats' weight could be potentially a confusing factor, e.g. the more obese rats to have greater OC scores lesions. This assumption was investigated. Also, detailed pathologic [7] study and grading of OC findings was performed by scores, this is: 0 lesions were not found, 1 mild lesion was found, 2 moderate lesions were found and 3 serious lesions were found. The previous grading was transformed as follows: (0-0.499) without lesions, (0.5-1.499) the mild lesions, (1.5-2.499) the moderate lesions and (2.5-3) the serious lesions damage, because the study concerns score ranges rather than point scores. OC scores were measured by 1st Department of Pathology at Department of Clinical-Laboratory studies in Faculty of Medicine of Athens University. Click here to view Large Table 1 Model of ischemia-reperfusion injury Control groups: 20 control rats (mean mass 252.5g [SD: 39.31988g]) experienced ischemia for 45min followed by reperfusion. Click here to view Large Table 2 Group A: Reperfusion lasted for 60min (n=10 controls rats) mean mass 243g [SD: 45.77724 g], mean mild OC score 0.5 [SD: 0.5270463] (Table 2). Group B: Reperfusion lasted for 120 min (n=10 controls rats) mean mass 262g [SD: 31.10913 g], mean without lesions Erythropoietin group: 20 Epo rats (mean mass 242.9g [SD: 30.3105g] experienced ischemia for 45min followed by reperfusion in the beginning of which 10mg Epo/kg body weight were IV administered. Group C: Reperfusion lasted for 60min (n=10 Epo rats) mean mass 242.8g [SD: 29.33636g], mean without OC score 0 [SD: 0] (Table 2). Group D: Reperfusion lasted for 120min (n=10 Epo rats) mean mass 243g [SD: 32.84644g], mean without lesions OC score 0.3 [SD: 0.4830459] (Table 2). Statistical analysis Click here to view Large Table 3 Every weight and OC lesions score group was compared with each other from 3 remained groups applying statistical standard t-tests and Wilcoxon signed-rank tests respectively (Table 3). If any probable significant difference among OC lesions score was raised, it would be investigated whether owed in any respective probable significant mass one (Table 3). Then, the application of generalized linear models (glm) was followed. It included as dependant variable the OC lesions scores. The 3 independent variables were the Epo administration or no, the reperfusion time and their interaction. Inserting the rats' weight as independent variable at glm, a non significant relation turned on with OC scores lesions (p=0.0585), so as to further investigation was not needed. The statistical analysis was performed by Stata 6.0 software [Stata 6.0, StataCorp LP, Texas, USA] [5]. Go to Results The glm resulted in: Epo administration significantly decreased the OC scores by 0.3 [-0.6200848 - 0.0200848] (p= 0.0654). This finding was crepant with the results of Wilcoxon signed-rank test (p= 0.0339). Reperfusion time kept non-significantly increased the OC scores by 0.1 [-0.2332897 - 0.4332897] (P=0.5472), approximately in accordance with the Wilcoxon signed-rank test result increased by 0.4 [-0.7185105 - -0.0814895] (P=0.0190). However, Epo administration and reperfusion time in combination non-significantly decreased the OC scores by 0.1090909 [-0.3078424 - 0.0896606] (p= 0.2735). The above and Table 3 are summed in Tables 4 & 5 [6,7]. Click here to view Large Table 4 Click here to view Large Table 5 Go to Discussion The following situations show the association between ischemia and congestion in oviducts. Ajayi OL et al. [8] observed severe congestion, hyperemia, edema, dilatation and devitalization in the affected portion of an oviductal 360 degrees volvulus clockwise around the dorsal ligament during routine postmortem examination in an 11 months old chicken (Gallus gallus domesticus). Gordts S et al. [9] elucidated the process of human ovum retrieval by fimbriae. The fimbriae on the ovulatory side appeared congested, tumescent and showed pulsatile movements synchronous with the heartbeat. Vascular congestion causing erection and pulsatile movements of the fimbriae play a role in the retrieval of the ovum. Tuffrey M et al. [10] suggested that severe mucus congestion accompanied by tubal edema and loss of ciliated epithelia play a major role in the aetiology of chlamydial-induced tubal damage. Kleinstein J et al. [11] supposed that the oviduct damage caused only by the mechanical influence of the secretion congestion is the reason for the unfavorable pregnancy rate after salpingoneostomy of a chronic atrophied hydrosalpinx. Thus, congestion is associated with Epo not only in oviducts but also in different tissues. Rashed FK et al. [12] showed short-term protective efficacy of Epo in rat testicular IR injury although vascular congestion [12], edema, hemorrhage and acute inflammation were observed in some groups. McMurray JJ et al. [13] described the long duration heart failure in patients treated by a-darbepoetin who had more signs of congestion. Lagarto A et al. [14] showed weak edema and vascular congestion in the right nostril of all control and treated Wistar rats groups, after 15|il Epo administration, similar to that produced in the brain during hypoxia. Zheng L et al. [15] might improve aortic stenosis induced pulmonary congestion in patients treating pre-operative aortic valve replacement with rhEpo in a mouse model. Piloto N et al. [16] supposed heart failure as sudden death cause in died rat's tissues presented [16] with brain vascular congestion. Naito Y et al. [17] investigated the mechanisms of cardiac remodeling induced by 20 weeks iron deficiency anemia promoting lung congestion, with decreased serum Epo concentration. Kiris I et al. [18] showed that Epo significantly decreased the focal glomerular necrosis, dilation of Bowman's capsule, degeneration and necrosis of tubular epithelium, interstitial inflammatory infiltration and congestion of blood vessels induced by aortic IR in rats. Minamishima YA et al. [19] demonstrated premature mortality associated with marked venous congestion in mice lacking enzyme PHD2. Lee TH et al. [20] noted splenomegaly caused by the congestion of red pulp in a mouse model deficient in peroxiredoxins II-/-, although healthy in appearance and fertility. Ruschitzka FT et al. [21] treated polyglobulic transgenic mice over expressing hEpo by NO synthase inhibitor N(G)- nitro-L-arginine methyl ester (L-NAME) and revealed acute left ventricular dilatation and vascular engorgement associated with pulmonary congestion. Gentz EJ et al. [22] revealed pulmonary congestion resulting from polycythemia 74% due to high serum Epo concentration in a llama. Specially, oviducts and Epo are associated in the following situations. Lappin T [23] supposed that the beneficial effects of hEpo may extend to organs such as ovaries, oviducts, uterus which has Epo receptors. Sasaki R et al. [24] claimed that Epo is both estrogen inducible and produced in oviducts. Masuda S et al. [25] found E2 and hypoxia induced, transient, rapidly down- regulated stimulation of Epo mRNA in oviductal ampulla and isthmus regions. The E2 action is probably mediated through the E2 receptor and de novo protein synthesis is not required for E2 induced Epo mRNA. Ochiai H et al. [26] attained the synthesis of hEpo protein attempting localized in-vivo plasmid DNA gene transfer in laying chicken oviducts. Go to Conclusion Epo administration decreased the OC score lesions in oviducts, however, within the same grade class. A longer study time or a higher Epo dose may reveal more significant results. For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com/ for more details click on the juniper publishers material science

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