#Clinical Research Near Me

[clinfinite123solution]

Blood Collection Methods: Essential Techniques for Accurate Diagnostics - By Clinfinite Solutions

At Clinfinite Solutions, we perceive that precise blood collection is a vital stage in the demonstrative cycle. Blood tests give significant bits of knowledge into a patient's wellbeing, empowering medical care experts to analyze conditions, screen infections, and assess by and large prosperity. Nonetheless, the precision of these tests to a great extent relies upon the blood collection method utilized. In this blog, we will investigate different blood collection methods, their importance, and how Clinfinite Solutions guarantee elevated requirements in each methodology.

Significance of Right blood collection methods

Blood collection is a delicate and exceptionally specialized process that requires cautious meticulousness. The strategy picked for drawing blood can influence the consequences of a test, and inappropriate procedures can prompt tainting, test debasement, or inconvenience for the patient. Off base blood collection strategies can likewise prompt misdiagnosis, postponed treatment, or superfluous systems.

At Clinfinite Solutions, we guarantee that all our blood collection methods are directed via prepared experts who adhere to industry rules. We want to furnish medical services suppliers with exact outcomes so they can offer the most ideal consideration to patients.

Normal blood collection methods

There are a few blood collection methods, each appropriate for various purposes. The decision of technique relies upon the idea of the test, patient variables, and the necessary example type. Underneath, we examine the most regularly utilized blood collection strategies:

1. Venipuncture (Venous Blood Arrangement)

Venipuncture is one of the most notable blood grouping techniques and incorporates drawing blood from a vein, regularly in the arm. This system is regularly preferred considering the way that it gives a greater volume of blood, making it sensible for a large number of tests.

The methodology includes embedding a needle into a vein, generally in the antecubital fossa (the region before the elbow), where veins are not difficult to find. Clinfinite Solutions guarantees that the methodology is finished with negligible distress to the patient and that the example is gathered accurately to keep away from hemolysis or coagulation.

2. Slim Blood Collection (Fingerstick or Heelstick)

Slender blood collection is a less intrusive technique and is regularly utilized for pediatric patients, those requiring more modest blood tests, or for fast purpose in care testing. This strategy includes pricking the skin with a little lancet to gather blood from the vessels, regularly from the fingertip in grown-ups or the heel in babies.

Slender blood collection methods are especially helpful for tests like glucose observing, cholesterol testing, and hemoglobin levels. In spite of the fact that it is less obtrusive, a legitimate method is fundamental to try not to defile the example with interstitial liquid, which could influence test results.

Clinfinite Solutions trains medical services suppliers to painstakingly pick the right site and strategy for hairlike collection, guaranteeing exact examples without fail.

3. Blood vessel Blood Collection

Blood vessel blood collection is a specific method utilized fundamentally to gauge blood gases and evaluate oxygen and carbon dioxide levels. This strategy includes drawing blood from a conduit, normally the outspread or femoral supply route, instead of a vein. It requires more ability than venipuncture, as corridors are more profound and require cautious taking care to stay away from inconveniences.

Blood vessel blood collection is normally performed when a more exact examination of a patient's respiratory capability is required, like in basic consideration settings or for patients with respiratory problems. Clinfinite Solutions utilizes the most recent gear and conventions to guarantee protected and successful blood vessel blood collection.

4. Fine Blood Collection for Babies (Heelstick)

For infants, heelstick blood collection is the standard technique for acquiring limited quantities of blood for tests, for example, infant screening and blood glucose checking. This technique includes utilizing a lancet to prick the impact point of the newborn child, guaranteeing a speedy, safe, and negligibly excruciating methodology.

At Clinfinite Solutions, we grasp the significance of making the experience as agreeable as feasible for both the infant and the guardians. Our experts are prepared in delicate methods to limit trouble during the methodology.

Factors Affecting blood collection methods

The decision of blood collection technique is affected by a few elements, including:

Patient Age and Condition: Babies, older patients, and those with ailments might require explicit strategies to guarantee precise outcomes and limit distress.

Kind of Test: Certain tests might require a particular blood collection technique. For instance, venous blood collection is liked for thorough blood boards, while hairlike collection might be utilized for glucose testing.

Test Volume: A few tests require a bigger volume of blood, making venipuncture the most ideal choice, while others can be directed with a more modest example from a slender collection.

Simple entry: The area of the veins or conduits and the patient's life systems can impact the picked technique. For instance, veins might be hard to situate in fat or dried out patients, requiring an elective methodology.

Best Practices in Blood collection

At Clinfinite Solutions, we stick to severe conventions to guarantee the best expectations of care during blood collection. Our accepted procedures include:

Legitimate Preparation: Our experts go through far reaching preparation to dominate different blood collection strategies, guaranteeing they are fit for carrying out the methodology securely and really.

Patient Comfort: We focus on the solace and prosperity of our patients, doing whatever it may take to limit agony and tension during blood collection.

Cleanliness and Sterility: We keep up with severe cleanliness principles, utilizing sterile gear to stay away from pollution and lessen the gamble of contamination.

Appropriate Dealing with: We follow the accepted procedures for test taking care of forestall corruption, guaranteeing that the blood test stays in one piece until it arrives at the lab for examination.

Conclusion

Blood collection methods are a fundamental piece of the symptomatic cycle, and Clinfinite Solutions is focused on guaranteeing exactness, wellbeing, and patient solace in each method. By utilizing the right blood collection technique, medical care suppliers can get solid outcomes that are indispensable for powerful analysis and therapy. Whether it's venipuncture, slim, or blood vessel blood collection, our specialists are committed to utilizing the fitting technique to address every patient's issues. At Clinfinite Solutions, we accept that accuracy in blood collection is the most important move toward better tolerant consideration.

[salemontrial]

Unimaginably important addition

Another addition as someone with early onset psychosis, I encourage any early 20s or teenagers who are concerned to take the screening and test as well. It's rare but if it does manifest early it's good to catch it before it spirals out of control. There are resources available to you as a teenager with a schizospec disorder, and I promise you aren't as isolated as you feel

Especially for my Australian friends, I know a lot of Headspace clinics are whack but if you don't have access to anything else and your location is okay, from experience their early psychosis program is pretty good. From there you have quite a few options and I recommend checking them out if you feel concerned because they're very accessible to minors (most regular medical clinics ive been to offer a mental health plan for a few free Headspace sessions) and Headspace specifically caters to teenagers and young adults

Disability pride month PSA that schizophrenia and related disorders often starts to present in your mid 20s, so if things have been getting harder, life is less manageable, you feel less and less connected to reality, don't be afraid to get an assessment. It is not life ending, and living as someone with schizophrenia is worthwhile!!! It is a neurodivergence like any other, one that is disabling but doesn't make you less human. Getting early screenings and treatment is shown to give better outcomes for patients!!

[sugunahospital]

What are the Types and Treatments for Arthritis?

Many of us aim to move freely without discomfort throughout our lives. However, life’s challenges often include maintaining stable health as our bodies undergo wear and tear, leading to pain and discomfort.

When it comes to mobility, one prevalent condition worldwide is Arthritis, causing concern for many. Yet, Expert Orthopedic Doctors associated with the Leading Arthritis Treatment Hospital in Bangalore assure that successful methods exist today to manage this condition..

A bit of awareness and taking care at the right time can help a lot

Understanding Arthritis

The Best Knee Specialists in Bangalore at Suguna Hospital describe Arthritis as a condition that causes swelling and tenderness in one or multiple joints throughout the body. As your age or with certain health issues like high blood sugar levels, this condition may worsen.

Different Types of Arthritis

Arthritis isn’t restricted to a particular age but is commonly noticeable in later stages.  

Some of the common types are:

Osteoarthritis –��Affecting joints in your Hands, Knees and Spine.

Psoriatic Arthritis – Caused due to a very complicated skin disease called Psoriasis, this condition can be very challenging.

Reactive Arthritis – This causes joint pain and swelling. It is caused either due to infection or malfunction of key organs of your body including the intestines, genitals, or urinary tract.

Rheumatoid Arthritis – This is a chronic inflammatory disorder. In addition to affecting the different joints, it can deeply impact premier organs like heart, lungs and eyes.

When to See a Doctor? Experts recommend seeking immediate medical attention if you notice specific symptoms, like

Stiff joints

Acute pain in the joints

Difficulty in moving or standing

Swelling observed in or around the joints

Redness observed in the joints

Treating ArthritisManaging Arthritis requires a systematic approach. It’s crucial not to overlook persistent symptoms as mere discomfort. Ignoring these signs can lead to costly consequences. 

Your treatment is based on how severe is your condition and can include: 

MedicationsDepending upon the type of Arthritis diagnosed, your medications may include:

Ointments

Steroids

Physiotherapies and light workouts to begin with

SurgeryThis is the last resort which your doctors might recommend only if there are no signs of improvement after persistent medication.  Some of the types of surgeries successfully performed include,

Joint Repairs

Joint Replacements

Overcome Arthritis and lead a pain-free, confident life. Avoid welcoming Arthritis! Consult the top Arthroscopy Surgeon  in Bangalore at Suguna Hospital for a safe and successful journey ahead.

[ccrpsorg]

Medical Research Jobs

Medical research jobs provide individuals with the opportunity to make significant contributions to the advancement of medicine and healthcare. These positions involve conducting clinical trials, laboratory research, and analyzing data in order to develop new treatments for diseases. Working in medical research requires a high level of scientific knowledge, analytical skills, and critical thinking. Professionals in this field often collaborate with other researchers from different disciplines to conduct studies that aim to improve patient care and treatment options. Medical researchers also work closely with doctors, nurses, and other healthcare professionals so they can share their findings and better understand patient needs. With such a wide range of responsibilities, medical researchers play an essential role in driving innovation in the medical industry. The advancement of modern medicine is dependent on the insights that these professionals provide through their investigations. As such, medical research jobs offer ambitious individuals the chance to make a meaningful contribution to humanity’s ever-evolving knowledge of health and well-being.

Clinical Research Associate (CRA): Designs and implements clinical trials according to established protocols. Monitors the progress of trials and reports results to principal investigators. Salary range from $50,000 to $90,000 per year. CRA Certification through CCRPS requires completion of a 8-week course on research principles and methodology plus two years of experience in clinical research related activities such as site monitoring or data management.

Clinical Research Coordinator: This position involves coordinating the clinical aspects of research studies, such as collecting and organizing data, tracking recruitment of study participants, managing patient information, and monitoring research protocols. Salary range: $43,000 to $55,000 per year. Get CRC Certification through CCRPS: Certified Clinical Research Professional (CCRP).

Clinical Trials Manager (CTM): A Clinical Trials Manager is responsible for overseeing the entire clinical trial process from start to finish. They ensure the compliance of all study protocols while managing timelines and budgets. Salary range: $70,000-$90,000 per year; Certification through CCRPS: Certified Clinical Trial Manager (CCTM).

Medical Research Lab Technician: Responsible for performing laboratory tests according to established protocols in order to aid in medical research projects. Salary range: $35,000 to $45,000 per year. Certification through CCRPS: Certified Laboratory Technician (CLT).

Bioinformatics Scientist: Utilizes computer technology and statistical analysis in order to analyze biological data derived from experiments in medical research labs. Salary range: $75,000 to $100,000 per year Certification through CCRPS: Certified Bioinformatics Scientist (CBS).

Medical Writer: Writes and edits materials for clinical trials and other medical research projects, including study protocols and reports for publication or regulatory submission purposes. Salary range: $60,000 to $80,000 per year Certification through CCRPS: Certified Medical Writer (CMW).

Regulatory Affairs Manager: Manages the regulatory affairs process by ensuring that medical products adhere to applicable regulations throughout their development and commercialization phases. Salary range: $95,000 to $125,000 per year Certification through CCRPS for Certified Regulatory Affairs Manager (CARM)

Regulatory Affairs Specialist: Develops regulatory strategies for the submission of clinical trial applications to regulatory agencies, monitors global regulations governing clinical trial design and implementation and tracks changes in legislation affecting the development process of drugs, biologics or medical devices; coordinates communication between sponsors, investigators and regulatory authorities; prepares high-quality documents such as study protocols and amendments for submissions to regulatory bodies; participates in meetings with regulatory agencies worldwide; performs literature searches related to drug development topics; assists with ongoing maintenance of regulatory files as required by regulations. Salary range from $55,000 to $100,000 per year depending on experience level. Pharmacovigilance Certification through CCRPS requires completion of a 8-week course on research principles and methodology plus five years minimum experience in pharmaceutical industry or related fields with emphasis on Regulatory Affairs functions.

[croservices]

Get Better CLINICAL RESEARCH ORGANIZATION NEAR ME Results By Following 3 Si

1. Clinical research organizations: What to look for

When you are looking for a clinical research organization (CRO), there are a few things you should keep in mind. First, you want to make sure that the CRO has experience with the type of research you are looking to conduct. Second, you want to be sure that they have a good track record and are able to provide the services you need. Finally, you want to be sure that you are comfortable working with the CRO and that they are able to meet your deadlines.

The first thing you want to do when looking for a CRO is to ask around. Talk to your colleagues, friends, and family to see if they have any recommendations. Once you have a few potential CROs in mind, you can start to research them further.

When you are looking at a CRO, you want to make sure that they have experience with the type of research you want to conduct. You can find this information on their website or by contacting them directly. Be sure to ask about their experience with the specific type of research you want to conduct.

Next, you want to look at the CRO’s track record. Make sure to look at their past projects and see how they have performed. You can find this information on their website or by contacting them directly. Be sure to ask about their success rates and any awards they have won.

Finally, you want to be sure that you are comfortable working with the CRO. Be sure to schedule a meeting or a call to get to know them better. During this meeting or call, be sure to ask about their communication style and their ability to meet deadlines.

By following these three simple tips, you can be sure that you find the best CRO for your needs Clinical research organization near me.

2. How to get the best results from clinical research organizations

If you are looking to improve the quality of your clinical research, it is important to partner with a reputable clinical research organization (CRO). A CRO can help you design and conduct clinical trials, as well as manage data and safety monitoring. In this blog, we will discuss three tips for getting the best results from your CRO.

1. Define your goals upfront

Before you start working with a CRO, it is important to have a clear understanding of your goals for the clinical trial. What are you hoping to achieve? What are your primary and secondary endpoint? What are your inclusion and exclusion criteria? By having a clear understanding of your goals, you will be able to more effectively communicate with your CRO and ensure that they are on the same page.

2. Choose a CRO with experience in your therapeutic area

When selecting a CRO, it is important to choose one with experience in your therapeutic area. This will ensure that they have a good understanding of the regulatory landscape and can help you navigate the clinical trial process. Additionally, they will be familiar with the relevant literature and can provide valuable insights.

3. Be prepared to provide feedback

Throughout the clinical trial process, it is important to provide feedback to your CRO. This feedback can be used to make adjustments to the trial design or protocol. By being proactive and providing feedback, you can help ensure that the clinical trial is successful.

By following these tips, you can improve the likelihood of success for your clinical trial. If you have any questions about how to select a CRO or how to conduct a clinical trial, please contact us. We are here to help you every step of the way.

[fmk-marketing]

Best Child Specialist in Kanpur | Dr Nidhika Pandey

Dr. Nidhika Pandey is a renowned child specialist in Kanpur, India. She has extensive experience in the field of pediatrics and is known for her compassionate care for children. Dr. Pandey’s dedication to her profession has earned her the title of the Best Child Specialist in Kanpur.

Dr. Nidhika Pandey graduated from the prestigious SRMS Medical College . She completed her residency in Pediatrics at the same institution. completing her training, she started practicing as a pediatrician in Kanpur.

Over the years, Dr. Pandey has gained a reputation for her expertise in treating a wide range of pediatric conditions. She has a particular interest in child development, nutrition, and behavioral issues. Her patients appreciate her kind and caring approach towards children and parents alike.

Dr. Nidhika Pandey clinic is equipped with the latest technology and equipment to provide the best possible care to her patients. She uses evidence-based practices and the latest medical research to determine the most appropriate treatment for each child. She also provides vaccination services to protect children from serious infectious diseases.

Dr. Pandey’s commitment to her patients goes beyond her clinic. She is actively involved in community outreach programs to promote child health and wellness. She conducts educational sessions for parents on various child health topics and participates in health camps to provide medical care to underprivileged children.

In conclusion, Dr. Nidhika Pandey is a highly respected and experienced child specialist in Kanpur. Her exceptional medical skills, compassionate care, and dedication to her patients have earned her the title of the Best Child Specialist in Kanpur. Parents can trust her with the health and well-being of their children.

[copperbadge]

How did you find the doctor(s) who assessed you for ADHD? Im looking into the process of getting diagnosed because (although ive suspected I might have adhd for years now) I've been struggling a lot more lately and i want to try medication to see if it helps at all. Im trying to search for psychiatrists through my health insurance portal but the the results im getting are all for child/adolescent psychiatry specialists, and I dont think that'll be much help for an adult adhd assessment? Did you have an established therapist to refer you for your assessment or were you able to find a psychiatrist independently?

I actually just kind of had to freeform it, but that does mean I have some tips to share!

I will say, I have never once used a health insurance portal to find someone to treat me for anything. Often their search engine is fucked up and the information is sometimes out of date. I almost always either ask someone who I know has had similar issues if they have a recommendation, ask my treating physician if I have one, or just google until I find someone reputable-looking; any qualified medical center or professional will list what insurance they take anyway, and you can always ask when you make the appointment.

So here's the process for how to do that!

When I was first considering it, I asked a friend who'd had an evaluation that came back not-ADHD, which I liked because it meant we knew it wasn't like, a weird Adderall pill mill or something. I really wanted to have a professional and thorough evaluation because I knew myself and knew I was capable of gaming a questionnaire. The place she had her evaluation was unfortunately having some staffing issues; part of the reason it took me so long is that I played phone tag with them for ages -- I'd call, and regardless of what time of day I called, their scheduler would be "out", so I'd leave a message and never get a call back. Ultimately I said "I really need to talk to a human, because your scheduler has not returned any of my numerous calls" and they said they could transfer me to another office outside of Chicago (in the burbs). That was not going to be accessible to me, so I told them thanks but I'll go somewhere else. Then COVID hit and I was not going to go anywhere near a medical center unless I had to for about two years.

So, when I was making my second serious run at getting evaluated, I did what might be expected of me by longtime readers of this blog: I made a spreadsheet.

I want to caveat this up top with REALLY IMPORTANT CONTEXT: I did not do all of this in a single day. The process from starting research to making an evaluation appointment took about a month, and probably would have taken longer if I wasn't getting somewhat desperate. Do not push yourself to do this as a single act. Research alone is a multi-day process; some days I looked at the open tabs and only entered one tab's worth of information. It took me quite a bit of time to write the form email I sent inquiring about an assessment. It took me time to call the clinic back when they asked me to call to book the appointment. This is a series of steps, not a single leap.

So!

I was looking for a clinic rather than an individual, in part because I'd heard a couple of horror stories about people who went to a psychiatrist and just got argued with for an hour instead of actually getting evaluated. So I googled, and here are some key terms for you, chicago adult adhd assessment. Chicago obviously for the region, but "adult adhd" (putting it in quotes will help) is the important term that will help you filter out a lot of child psych stuff. A lot of what I looked at did included family or child assessment/therapy but were clear that they also evaluated adults.

Then I went through every legit-looking search result and noted down, in my spreadsheet, the name of the clinic/company, the contact phone and email, the URL, the physical location (I needed to be able to get to it fairly easily) and whether they took my insurance. Even if they didn't take my insurance (all but one did) I still put them into the spreadsheet so that if I found them again I could check the sheet and know I didn't need to investigate further. I also tended to bump more legitimate and friendly-looking places to the top of the sheet. And if I were going to do it again I would also look for one specific thing, which is an assessment guide of some kind.

The assessment guide may be something they only give you after you speak with them, so it's not a no-go if they don't have one on their website, but it basically tells you what generally will go on during the assessment, how long it will take, and what you should bring. A full assessment like I had is estimated to take 4-6 hours and they recommended I wear layers so I wouldn't be overly cold/warm in their office, and to bring a snack. That's the kind of information you want, duration of the assessment and what they recommend for you, to ensure that you're working with people who are thorough and care about your comfort.

So, I have this spreadsheet now of places to reach out to, which I know take my insurance and do adult assessment. In the spreadsheet I also had columns for what date I contacted them and whether they'd responded. I started reaching out via email, one per day, with the form email I'd written.

The form email basically said "I'm 42 with no previous diagnosis but I have a family history of autism and dyslexia. I've been told I should get assessed for ADHD, so I'm looking for a clinic that will do the assessment and takes (my insurance). I prefer to be contacted by email but if need be, my phone number is (phone number). Please let me know if you have any open appointments and what information you will need from me to book an evaluation with you." (You can always ask for more information about the actual evaluation process once they respond.)

If I didn't get a response within 24 hours, I moved on to the next, but I only greyed out the text in that line of the spreadsheet; I didn't disqualify/remove the nonresponsive ones because again, I wanted to make sure I kept that information in case they eventually did respond. I did this with about ten clinics, because I figured I must be able to find at least one in ten who could do the eval, and I could go back and research more if necessary.

I think the third or fourth one I reached out to was the first to respond, and I ended up going with them; I had a very positive experience in the assessment itself but it was a real pain in the ass getting the documentation from them -- they took about a month to go through the evaluation data (this is not abnormal but is rather longer than usual according to my psychiatrist) and they gave me an in-person-by-zoom report once it was ready. That said, it took another four months and the threat of reporting them to the state to get them to send me the text of the eval (in part because the evaluator left the clinic unexpectedly with my formal report not yet written). But that's something that's truly impossible to know until you're working with them, and highly unusual, so don't let concerns about that deter you. If you end up in that situation come hit me up and I'll tell you how I dealt with that.

My eval recommended an executive function coach, but if I haven't been able to func it by now I never will, so I thanked them for the recommendation and went looking for a psychiatrist unaffiliated with the clinic to prescribe me meds. There, the key words you're going to be looking for are again "adult adhd" but also "adult disability" and if you want medication that's less likely to be a huge fucking hassle, "medication management". My psychiatrist and I meet every two months to reup my prescription, but he doesn't require me to take a regular drug test or meet him in person in order to get a new scrip, as some people have encountered. We meet in person once or twice a year (I can't remember, it's due to a legal requirement in Illinois) but otherwise it's over zoom.

So yeah -- it's a process, but there are ways to streamline and manage it, and a few tripwires in place to make sure you don't end up screwed by the system. Definitely feel free to ask if you have questions, either here or if you want a more indepth conversation you can email me at copperbadge@gmail.com. GOOD LUCK!

[afeelgoodblog]

The Best News of Last Week

🦾 - High-Five for Bionic Hand

1. Houston-area school district announces free breakfast and lunch for students

Pasadena ISD students will be getting free breakfast and lunch for the 2023-24 school year, per an announcement on the district's social media pages.

The 2023-24 free lunch program is thanks to a Community Eligibility Provision grant the district applied for last year. The CEP, which is distributed by the Department of Agriculture, is specially geared toward providing free meals for low-income students.

2. Dolphin and her baby rescued after being trapped in pond for 2 years

A pair of dolphins that spent nearly two years stuck in a Louisiana pond system are back at sea thanks to the help of several agencies and volunteers.

According to the Audubon Nature Institute, wildlife observers believe the mother dolphin and her baby were pushed into the pond system near Grand Isle, Louisiana, during Hurricane Ida in late August 2021.

3. Studies show that putting solar panels over waterways could boost clean energy and conserve water. The first U.S. pilot project is getting underway in California.

Some 8,000 miles of federally owned canals snake across the United States, channeling water to replenish crops, fuel hydropower plants and supply drinking water to rural communities. In the future, these narrow waterways could serve an additional role: as hubs of solar energy generation.

4. Gene therapy eyedrops restored a boy's sight. Similar treatments could help millions

Antonio was born with dystrophic epidermolysis bullosa, a rare genetic condition that causes blisters all over his body and in his eyes. But his skin improved when he joined a clinical trial to test the world’s first topical gene therapy.

The same therapy was applied to his eyes. Antonio, who’s been legally blind for much of his 14 years, can see again.

5. Scientists develop game-changing vaccine against Lyme disease ticks!

A major step in battling Lyme disease and other dangerous tick-borne viruses may have been taken as researchers announced they have developed a vaccine against the ticks themselves.

Rather than combatting the effects of the bacteria or microbe that causes Lyme disease, the vaccine targets the microbiota of the tick, according to a paper published in the journal Microbiota on Monday.

6. HIV Transmission Virtually Eliminated in Inner Sydney, Australia

Sydney may be the first city in the world to end AIDS as a public health threat by 2030. Inner Sydney has reduced new HIV acquisitions by 88%, meaning it may be the first locality in the world to reach the UN target to end AIDS as a public health threat by 2030

7. New bionic hand allows amputees to control each finger with unprecedented accuracy

In a world first, surgeons and engineers have developed a new bionic hand that allows users with arm amputations to effortlessly control each finger as though it was their own body.

Successful testing of the bionic hand has already been conducted on a patient who lost his arm above the elbow.

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That's it for this week :)

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Support this newsletter ❤️

Also don’t forget to reblog.

[ambiguouslady42]

Pairing: you (the little elf) x Byakuya Kuchiki. Lots of other really awesome Bleach characters too!

Genre: So much fluff. Action sequences and banter are similar to what you would find when watching Bleach.

WC: 5.6K

A Secret Santa @pixelcafe-network collab.

Note: Merry Christmas, Whitney (@cherryblossombankai)! I was your Secret Santa all along! I asked you all those questions, and this was the end result. I hope that you enjoy it. Writing this was a real treat for me and it reminded me why I fell in love with Bleach when I first started watching it. I hope that you get everything you want and more in 2025.

Major thank you to @actuallysaiyan and @villainsrtasty for the beta-read. <3

It’s December and you’re currently living in Karakura Town in Japan. This is your first time travelling far away from your family and friends. It felt like a sense of responsibility on your part to travel far away. From overseas, you’ve been hearing about people seeing strange figures. The investigative journalist within you thought it was farfetched that people could be seeing things. Curiosity piqued and you had to go and see this for yourself. The choice was spontaneous, despite acknowledging that you would miss out on the holiday season and your traditions; Matching pyjamas and Christmas movies are your comfort and your home, but for now, there are more pressing matters to address.

You took your time to become familiar with the locals of Karakura Town. You felt that you needed to ask if they had seen anything out of the ordinary, but most of them just either shrugged at you or gave you a glaring look before walking away. However, this did not deter you. You would do this daily from morning until nightfall. At the end of your day, you would stop by Mr. Urahara’s shop and grab a snack before heading back to your place. He always gave you a polite smile and made small talk with you.

“Did anybody talk to you today?” he would ask politely and hide his smile with his fan.

“No, they just look at me like I’m crazy, and then walk away. Can’t force people to talk to me if they don’t want”  you said with exhaustion in your voice. 

“If not today, maybe tomorrow!” he exclaimed. 

“Thanks, Mr. Urahara” you responded with a small smile.

You acquired an apartment near the shop. You often had ramen, your snacks, and a Ramune. Occasionally, you’d have a few beers, but you try to avoid it to not make it a habit.  The ache to know never stops; you don’t cease doing the research at home. You had a map layout of the places where the occurrences transpired. You would mark an “x” where you made an effort to talk to the locals in that area. You’re yet to go to two more areas to explore; nearby the clinic and the local high school. You prepare to go to bed and close your eyes tightly as you tell yourself, “I wish this is all real and I’m not just chasing a phantom.”

Morning arrives and with haste, you prepare a cup of coffee before heading out to start your day. Unbeknownst to you, Mr. Urahara watches you walk whenever you pass by and covers his face with his fan; he knows something, but it is not his place to get involved with the matters that you’re seeking answers to. He knows that when the time arrives, he will step in place to help you or anyone else who requires his help. 

You walk towards the high school. You attain permission to enter campus and walk around the field. You observe students exercising on this brisk morning. You take out your notebook and write down what allegedly transpired in this field. As you’re about to assume it’s another dead end, you hear students screaming. This alarms you and you wonder where the danger is. You stop one student and ask them if they’re okay. All you see is fear in their face; they look and point in the opposite direction. 

“Can’t you see it?!” they say as their teeth jitter and their entire body shakes before running away. 

You start to walk in that direction and overhear students asking.

“What’s wrong with them? There’s nothing there!”, they laugh. 

The joke is on them because suddenly one student is lifted mid-air and is seen to disappear. To your horror, you see a faint figure. It’s not very clear, but you see there’s something that is not of this world. Although, this time, you’re paralyzed. You want to scream and run as you see this monster, but you can’t. The monster begins to approach you and you can’t move. “Is this the end?” you thought. 

Just as you thought the end was near, eyes clenched and with shallow breaths, you hear a loud crash. As you slowly open your eyes, you see a tall man with orange, spiky hair. He holds a large blade as he strikes the monster on its shoulder. There is blood spraying, but you can’t manage to move. Suddenly, you feel a tug on your arm. 

“We have to go, MOVE!” commands the other stranger. It’s a short woman with a short black hair. Although small, she is strong and you feel her strength as she yanks out of harm’s way. You notice that she has a katana, but hasn’t drawn it yet. One thing you observe about both these individuals is that they’re wearing black robes and traditional footwear. You are curious if this is usual in Japan, or what their role is right now. You turn to look and the one with the orange hair strikes the monster head-on. Within a moment, the monster is obliterated and suddenly you see a human with chains. “Thank you,” says the stranger out loud and you observe them slowly disappearing. Having witnessed a lot, your vision goes black. “Hey! Stay with me!” you hear through an echo. 

You awaken and notice that you’re on the ground, resting on someone’s lap. It’s the same woman who pulled you away from the danger. You observe the other person who obliterated the monster earlier standing over you; his demeanour is serious, but clearly, he must care about your well-being if he remains there. You slowly get up and have a lot of questions. 

“Take it easy, are you alright?” he asks. 

“Yeah, I’m not sure if I just fainted or was dreaming”, you feel as if you had the wildest fever dream. 

“About that…”, says the woman. “What do you remember right now?” 

“I saw a monster, then I saw a human in chains, then they were just…gone?” you respond, but you feel crazy as you say this out loud. The two looking over you don’t try to deny what you saw. 

“That wasn’t a monster…it’s called a hollow. The hollow was once a lost human soul, and now they’re finally at peace.” 

“What? I don’t understand,” you state with a grim face. 

“That’s alright, it is a lot to take in at the moment. You technically aren’t supposed to see hollows, but you’re okay.” says the woman. “Allow us to introduce ourselves, I’m Rukia, and this is Ichigo. We’re soul reapers and we’re in charge of making sure souls can leave this place in peace.” 

“This place being…Earth?” you inquire.

“Yes. Whenever a human is left to roam after passing, they remain here because they haven’t been able to find peace. Over time they can become hollows, so we just assist them in finding that.” Rukia says gently. 

You scramble to find your notebook, but then you feel a grip on your wrist. “It would be best if you keep this information to yourself…it’s not meant to be common information for humans to know about this.” Rukia continues. 

Disappointment lingers as you are piecing together why humans disappear and what people have been able to see; they are like ghosts, but now it feels like a secret that you could never reveal to others.  “What are you doing in Japan? Was this a crazy idea?” You thought to yourself. As you sit in the ground contemplating you notice a shift in their demeanour. 

Rukia is looking with a look of shock and Ichigo is glaring.

“B..brother…what are you doing here?” Rukia asks, and then you look in the direction where she’s looking at. 

You see possibly the most beautiful man you’ve ever seen. His long, dark hair was a feature that stood out, but also his facial features were wonderful to look at. However, his stern face signalled to you that he currently isn’t here for any nonsense. 

“Let’s go, Rukia, you have no reason to be amongst these…humans.” 

Suddenly, you’re filled with defiance. You stand up and get in front of Rukia. There was something that encouraged you to not be afraid of this person. 

“With all due respect, she saved my life, and this human you refer to would be dead if it weren’t for her. So leave her alone,” you spoke with calm ferocity. 

He was confused that someone would ever speak to him in such a manner. He felt that he couldn’t relent to anyone who disrespected him, but he had an appearance to maintain. 

“Who do you think you are?” he asked you with poison in his tone.

You tell him your name, refusing to be intimidated by him, even though he is distracting to look at. 

“As nice it is to meet you, I need to make sure that my sister is safe and comes home with me. I don’t have time for formalities” 

“Yeah, and what if she doesn’t want to go home with you, Byakuya?” Ichigo speaks up. 

“Do you want to do something about it? I don’t think you can substitute Soul Reaper,” Byakua shoots back. 

Rukia noticing the tension mount, steps in front of you. “Stop it, I’ll go along with you…” Rukia yields.

“No, you’re not. You don’t have to go with him if you don’t want to,” you interject. 

Then you get a brilliant idea. “What if he stays here?” you say loudly, pointing to Byakuya. 

“Here?! Amongst us?!” Ichigo responds with shock on his face.

“Look, I don’t know what’s going on, but if he wants to protect her so badly, he could just stick around.” you persist. 

“No way!” Ichigo shouts. “There’s no room in my…” he stops. He realizes that he can’t state where Rukia is currently staying at his house. “It’s getting pretty crowded, and I don’t have time to host anyone else.” Ichigo scoffs. 

“Well, I have room in my place, but it’s rather small…” you quietly say. 

“Then it’s settled, I’ll stay with the human,” Byakuya states.

“Brother…you don’t have to stay here,” Rukia responds. 

“I need to know what you’re doing here amongst the humans…that’s if you’re doing anything at all. My job is to protect you, no matter what.” Byakuya asserts. 

“Alright, so it’s settled. Rukia will stay with me, and HE can stay with her.” Ichigo declares. 

You look at Rukia with uncertainty, but she nods to you as if she’s saying thank you for standing up to her. You have no idea what you just accepted right now, but you figured talking to a new person couldn’t hurt anyone…right?

Before everyone left you asked out loud, “Can anyone possibly help me out with helping him appear more…normal?” 

Byakuya remained with a straight face, but internally, he felt embarrassed that a human was referring to his appearance as not normal. “Excuse me?” he asks. “I’ll have you know that I’m a Captain of the 13 Court Guard Squads.” 

“While that sounds important, your sister informed me that the less I know, the better. Right now, unless you don’t want me to write about you, you need to stop talking,” you say firmly. 

For once, he is astounded by the tone someone speaks to him. Aside from the disrespect he feels from you, he is also impressed that anyone can utter anything to him in a way where they don’t defer to him. He is not a God in your eyes, but you will not allow anyone to push you or anyone else around. He gazes at you and there’s a light blush on his cheeks, but he sighs accepting that he must resign. If he must be within his sister’s reach and stop causing chaos in the World of the Living, he must stay with this stranger.

“Alright. Ichigo Kurosaki, is there a way that I can maintain appearances here in the World of the Living.”

“Me?! How am I supposed to help you?” responds Ichigo.

Within moments, Rukia hits Ichigo in the back of the head, for the blatant disrespect that he just displayed to her brother. “Oh brother, it’s no trouble at all! I’m sure Ichigo can be of great help here!” with a cheerful tone when addressing her brother. 

“Tch, fine, I’ll help. In the meantime,” Ichigo is looking in your direction, “you should come with us. Then he can go home with you or whatever…” 

Realizing what you’ve signed up for, your face is bright red as you look in Byakuya’s direction. He observes the way you’re looking at home, and his face is flushed.

“Brother…is everything okay?” Rukia asks, concerned.

Byakuya clears his throat. “I’m fine.”

“Let’s get going, it looks weird that we’re all standing around here in this empty field,” Ichigo states. 

As the four of you walk to leave the field, it’s silent. There is no small talk. Ichigo and Rukia are walking ahead of you. You look to your side and observe Byakuya. He is quiet and walks with a sense of purpose. However, you’re curious about what he could be thinking about. “Does he want to talk to me at all?”, you thought. 

He did have a lot of thoughts. The quiet and reserved captain did have a lot on his mind. He worries about his younger sister. He thinks about seeing you in the World of the Living. To his surprise, he wasn’t expecting to meet someone from this world to stand out to him. He takes notice that you’re quiet but also outspoken. “What other thoughts or ideas lurk within you?”, he thought. Regretfully, he didn’t bother to ask you anything on this walk towards Ichigo’s house. 

The walk remained silent and no one dared to say anything to break the tension. You get to Ichigo’s house and notice that this is the local clinic you often see when you’re walking around Karakura Town. it never stood out to you in any way, let alone that someone who calls themselves a Soul Repear would be living here. 

As you enter the home you are greeted by Ichigo’s sisters. While they gave him the third degree and questioned why they brought so many guests, Yuzu, relents and offers you dinner. As they’re about to deny the gesture, your stomach grumbles loudly. Everyone turns around to look at you. You’re glowing from embarrassment, but Yuzu just happily serves you a plate of katsu curry with some rice. She tends to overcook for everyone and she immediately gestures to everyone to go sit at the dinner table. 

Taking a bite of the warm meal, you feel a comfort in your stomach. It’s been so long since you had a proper meal that wasn’t just ramen noodles, coffee, energy drinks, or beer. There is a disappointment that lingers in the air as you cannot continue your investigation of what you thought would be a groundbreaking story. Byakuya chose to sit next to you, he looks at his meal curiously but does attempt to make a dent to not be impolite to his hosts. 

You make a calculated effort to make small talk with this handsome person as he’ll be staying with you very soon. “Have you never had this type of food before?” you say quietly.

He looks over at you and acknowledges the effort that you’re placing. He remains stoic, “I can’t say I’ve had a meal like this, but I can say that I am enjoying it the best I can”, he answers coldly. 

“I’m not from here actually, but I do find this meal comforting,” you say to him as you take another small bite. 

“Oh? Are you not from the World of the Living?” with curiosity in his tone. 

“I’m not from Karakura Town at all, or even this whole country. I hail from a different part of the world,” you share with him.

“Interesting. What brought you here?” he asks you. He is eager to know more about you. He is known within his circles to not make small talk, but you’re like a mystery waiting to be known.  

“I wanted, no…I needed to hear about the hollows, as you call them. People have disappeared and I wanted to know more. However, I feel like it might not be safe to talk about it…”

“You’re correct. Humans shouldn’t know too much about hollows or the supernatural events that they witness. It would create chaos in the World of the Living, and it would make matters more challenging for us in the Soul Society.” 

“Oh? The Soul Society?”

“Yes, that’s where I reside. It’s where spirits go when they pass on. I’m a captain, and I must protect the Soul Society, but also the World of the Living.” 

“Am I an anomaly for being able to see hollows?”

“Not necessarily. It just means that you’re just able to see spirits and hollows alike. You would just have to be careful if you encounter a hollow.” 

You reflect somberly. You realize that you did get lucky today that someone was there to save you from immediate harm, but you’re not sure if there will be a next time. Byakuya senses a shift, so he realizes he needs to make an effort to change the subject.

“Do you like sakura blossoms?” he asks you in a gentle tone.

The question catches you off guard, but there’s a warmth that you feel in thinking about this question. “I do, they’re one of my favourite flowers. I’d like to see them bloom in person someday”, you respond with a small smile on your face.

“Blossoms don’t typically bloom at this time of the year, but I might have something to show you a little later if that’s alright with you.” Byakuya shares with a small smile on his. 

“Brother, is everything okay?” Rukia asks. She observed that you’re smiling for the first time in so long. 

“I’m fine. Thank you.” He clears his throat. 

The silence lingers again. Ichigo signals Byakuya to follow him upstairs. Karin and Yuzu take care of clearing the plates and signalling to you and Rukia that you are their guests. Rukia knows that they have a lot of questions about you, but she knows that she’s welcome in the Kurasaki household. 

“So, what do you think of my brother?” Rukia asks nonchalantly.

“Oh, excuse me?” you choke on your sip of water.

“My brother isn’t one to make a lot of small talk. The fact that he made a genuine effort to talk to you might mean something. Don’t hesitate to take a chance if you feel happy right now.” Rukia says warmly. 

The words ring in your mind. You accept that something is intriguing about Byakuya, but you’re unsure if he would ever want to be involved with a human. There’s a distance between you two. You are attracted to him, but you have no idea if you have a shot with him. 

“I promise, he isn’t like this with anyone. Even with me, he doesn’t say a lot.” Rukia reassures you.  

You sit there and contemplate the weight of her words, and he appears in your peripheral. The first thing that appears is a slight giggle from Rukia, who is struggling to hold in her laugh. Ichigo standing right behind him is also stifling his laughter.

“What’s so amusing?” Byakuya asks. When you’re able to take a good look, you’re the first to burst out into laughter. He appears to be wearing a Hawaiian-style shirt, khakis, and a blazer. He is still wearing the scarf around his neck, as he refuses to remove it. However, he did remove his hairpieces from his hair and decided to put his hair up in a bun. 

“It doesn’t look bad…not that you look bad, it’s just different right now,” you respond with a small smile on your face. Your face feels hot in the moment and the room feels like it can suffocate you. 

“Would you change anything?” he asks concernedly. 

“I don’t think I can…I think you look great just the way you are.” you resign. 

He takes notice of your gaze. His face turns slightly pink, but he tries to remain unphased and clears his throat.  

You take note of the time and realize that it has been a long. You take a look at Byakuya. “Shall we get going?” 

“Yes…thank you again Ichigo Kurosaki. This…will do.” he says as he looks at Ichigo’s direction. 

“Take care, brother. I’ll see you tomorrow.” Rukia says quietly.

You take your leave and begin to walk outside the quiet streets. The streetlamps are and you feel a cool breeze between the both of you. You’re looking at him, but he doesn’t seem to say a lot. You’re unsure what you could say to him to break this silence. 

“Do you often come into the…World of the Living?” you ask.

“No. I’ve been here on many occasions. The first time that I stepped foot here was to retrieve Rukia, and…well, that was eventually a misunderstanding. Ichigo Kuraski was a great help in…helping me see the error of my ways.” he states.

“Oh…I thought initially you had come here because of the holidays.” 

“Well, if you mean Christmas, the Soul Society doesn’t necessarily celebrate it.” 

“Oh.” 

He notices that this conversation just ended, so he quietly thinks for a moment before saying something else.

“Do you…celebrate Christmas?”

“I do…but I won’t be able to see my family.” 

“Why is that?”

“I came here for work, but now I have to get creative and find a different story. I can’t write about you or the hollows,” you state solemnly.

“No, but maybe…we could bend the truth a little.”

“How so?” 

“I’m not in the habit of lying, but I’m sure there’s a way that you could talk about these…incidents without revealing who or what the Soul Society is.” 

“I’m not supposed to lie, I’m a journalist,” you respond bluntly. 

“I’m not telling you to lie. I’m simply telling you to bend the truth a little.” 

“I’m not sure how to go about that. It’s still lying.”

“No, it’s not. You’re not understanding me…” he states with frustration in his tone.

“I can’t stand you sometimes,” you mutter quietly.

“Excuse me?” he challenges you.

Suddenly, there’s a shift. Byakuya senses an extreme amount of spiritual pressure coming out of nowhere. The air feels strange and it feels like you can’t move suddenly. You want to run away, but you can’t; he observes your inability and grabs you to get you as far away from the danger. You don’t realize that he moved you in an instant and suddenly you aren’t where you previously were walking.

“Stay here”, he commands. He quickly disappears and faces the danger. 

He kept his zanpakto on him, exposed. He knew that there was always a possibility of danger, but it seemed that something attracted into the vicinity; it was you. He knows that’s a conversation that he’ll have to have later with you, but for now, he will address this problem. To his horror, he sees 6 hollows at the same time. There, is one hollow that is ferocious and hungry, complicating this matter. As the hungry one consumes and devours the weaker hollows, it turns into a Gillan, Menos Grande. 

It’s not a problem that he cannot deal with, but he became concerned with you. He needs to hurry before they take notice of you. He quietly says “scatter”. His zanpakto breaks into little tiny blades. He concentrates on his opponent and attempts to destroy the Menos Grande. The little tiny blades do not even scratch the surface. You witness from a distance how calm Byakuya remains, but you’re afraid. There’s a loud screech and you are deafened by it. The Menos Grande does not take the attack well. You observe how angry it is and suddenly it opens its mouth. You’re panicked at how it directs the attack towards Byakuya. 

Before the Menos Grade can attack with its Cero, Byakuya remaining calm says “bankai”. Within seconds before the ball of energy can be gathered, you observe a beautiful display of cherry blossoms. You watch how these beautiful blossoms are deadly. This beast never stood a chance as it became dissipated in an instant. 

“Is this what he wanted to show me earlier?” you thought to yourself. 

In moments, he comes back to your side. “Are you alright?”

“I am, but what’s going on? This is the second time this has happened today.” There are little tears flickering in your eyes. Without hesitation, Byakuya holds your hand for comfort. You look at him with the tears in your eyes. 

“Why?” you quietly ask. 

“I know this probably was a lot for you today. I’m going to make sure that you’re safe. It’s my duty to protect all humans.” his hand grips yours just a little tighter; a confirmation of a promise on his behalf that he will not let anything or anyone hurt you. 

“Thank you. I don’t want to burden you though.” 

“You’re not.” There’s a short pause. “I want to protect you.” 

“Even if I’m a human?” you ask.

He has a light chuckle. “I’m supposed to protect humans too. I’m saying…” with a short pause “that I’ll make sure you don’t get hurt.”

You're speechless; you remain quiet as you are walking back to your apartment. You’re not sure how you feel about the gesture, but you remember what you meant to ask him. 

“Did you want to show me your attack earlier?” 

“Yes and no. In the case of earlier, those blossoms are part of my special attack. I could show you a display of blossoms…without hurting you.”

“Why?” 

“After the horrors you saw today, I think you merit to see something beautiful.”

You stop walking and look in his direction. 

“Do…you see something beautiful right now?”

“Yes.” 

“Oh.”

He extends his hand and holds it. He takes a hold of your waist and you dash in an instant to the river. It’s just the two of you standing there. Out of nowhere, you see a flash of cherry blossom petals. It’s bright and beautiful to see. You’re in disbelief as you just met this person, and at first, you couldn’t stand him, but now, he’s showing this side of you out of nowhere. “What am I supposed to do now?” you thought. 

“This is…wonderful. Thank you”, are the only words that you can mutter at this moment. 

“Well, well! What a sight for sore eyes!” says someone.

You turn around and it’s Mr. Urahara. “What are you doing here?” you inquire.

“After I sensed that spiritual pressure and witnessed the Menos Grander earlier, I figured I should investigate what was happening. There’s a reason why I kept my eye on you.” his playful demeanour began to change to a more serious tone. “Since your arrival, the presence of hollows has increased in Karakura Town. I think there’s something about you that is attracting them; you smell of something and it makes them pop out like weeds. Luckily, your dashing Captain was here to save the day, but that’s not always the case for everyone.” 

Byakuya remained silent while Urahara was talking. When Urahara was done talking, he interjected to ask, “Is there a way to keep Hollows from trying to find her?”

“Sure. If she wants to remain here in the World of the Living, she will need to wear this necklace. I’ve been working on something like this for a while to see if I can prevent hollows from appearing near the shop, wouldn’t want any hollow to eat my customers.”

“I thought I was only your only customer”, you pipe up.

Urahara’s face turns bright red. He conceals it with his fan. “Another way that you could avoid this is…if you were to stay within the Soul Society.” 

“Why would you bring that up?” 

“You may not take off that necklace. I also forgot to mention that this necklace is not a foolproof way to prevent hollows from appearing. It may be possible that they could follow you wherever you go. Whether it’s here or outside of Karakura Town. So option 2, you go live in the Soul Society.” 

“Won’t I be considered dead?” 

“Not necessarily; it doesn't mean you would have to stay there forever. You would just need to be with a Soul Reaper at all times just in case any incident occurs.”

You remain quiet. You’re already homesick as it is, but then this was dropped onto your lap. 

“I’ll make sure she’s comfortable…” Byakuya says. 

“Why would you do something for me?” you ask him. 

“You didn’t ask for any of this. You are no burden to me, and as I said, I want to keep you safe and make you feel protected. Would you allow me this?” 

You feel something in your stomach; butterflies are forming. Up until now, you didn’t think it would be possible to feel this right now. You admire his ability to be confident and the subtle way he shows you that he cares about you. 

“Don’t hesitate to take a chance if you feel happy right now.” are the words that are ringing in your head.

“Okay, I’ll go. On one condition? I get to see my family when I can.”

“You can go for two seasons. You can go visit them in the Spring and Summer. You’ll be like a Goddess…gifting growth and splendour with your presence. I’ll be there, but I understand how important these trips to the World of the Living will be.”

“Byakuya…” you speak softly.

“I will protect you, respect you. If it becomes too much, just tell me. You’ll be comfortable, I guarantee that.” 

“Then it’s settled! You’ll go to the Soul Society and you’ll have a knight in shining armour when you come back to visit.” Urahara says with glee. 

Byakuya quietly glares at Urahara, but his expression changes upon looking at you. 

“Wait? What about Christmas? I can’t miss it!” 

“We do celebrate the holidays in the Soul Society, but not in the same way as you would here. To ensure your happiness…I will make sure to celebrate the holiday to your liking.” 

“Okay.” you smile at him. 

2 weeks later.

You spent your days at Byakuya’s manor. You had no idea he was of his nobility. He never bragged or talked about it, but your comfort was his primary priority. He always had his maids helping you get dressed for the day. You wanted to be respectful of Byakuya, so you wore a traditional kimono. The first moment he saw you, he told you how beautiful you looked. If the floor felt too hard for you, he immediately got extra pillows so your bum wouldn’t hurt. If it was raining, he’d hold an umbrella for you so you wouldn’t get wet.

He would do his Captain duties during the day, but he tried to settle for a routine when he could to spend time with you. You didn’t ask for any of this, but you liked the moments when you could just talk to him about his day. He enjoyed the quality time with you the most. He liked seeing you and making sure you were happy. You were content, but you felt like something was missing. He became aware of this when one of his maids shared that they caught you crying quietly in the garden. 

One day before Christmas, you were blindfolded and escorted somewhere. You weren’t sure where you were going, but Byakuya held you by your hand. 

“Almost there, I’m right here.” He told you. 

You feel the blindfold come off. You open your eyes and see a giant screen, and it’s your family. 

“Hello? Can you see us?” he asks.

“Yes! Oh my god! Why didn’t you tell us about this man? Why would you keep something like this from us?” 

You feel tears forming. This man in some way must love you to talk to your family and schedule this video call with them. 

“It just happened. He’s made sure that… I’m happy.” you say happily.

“When will get to meet him in person?” they continue to speak over each other.

“Maybe during the Spring? Can we visit for Spring and Summer?” you ask.

“Of course you can! We’ll show him everything there is to know about us and where we live.” your family replies ecstatically. 

“I’m making sure that she’s happy, I would hate to let you and her down at any point,” Byakuya interjects.

“So when’s the wedding then?” someone asks.

“Okayyyy. That’s enough. Merry Christmas everyone!” you signal to Byakuya to hang up the call. 

“Sorry about that. They can be…a lot sometimes,” you tell him with a hue of pink on your cheeks.

“It’s quite alright. As far as the wedding, it’s only until you say you’re ready. I’ll never force you to do anything.” he says warmly. 

As you both are walking through the wide doors, Byakuya stops. 

“Is there something wrong?” you look at him.

“No, but it seems there’s something above us.” he signals with his eyes that there’s mistletoe. 

“You know about mistletoe?” you ask him with a slight smirk.

“No, but that’s why I had people tell me about Christmas traditions,” he says proudly. “So may I have the honour of kissing you?”

“Yes…you may.” your eyes close as his lips ghost yours. The kiss is as soft and gentle as you imagined. 

“Merry Christmas,” he says and places a final kiss on your cheek. 

[sgiandubh]

It all starts with a smoke alarm

This wasn't supposed to happen like that, of course. It was supposed to happen with an ”allow me to introduce myself”, at the least. But hey, I am playing the cards I've been dealt, and since an anonymous ask on Tumblr does not allow pictures or links, this will have to do. We'll have plenty of time later.

Yesterday, I said that reading that Single Report reaped benefits. I have screen capped and summed up all the things that made me rise an eyebrow, to make things easier. Hopefully, this is going to be short: who would wax lyrical about a septic tank, after all?

I did not use my superpowers to do this, but simply the link provided by a very active Anon on several shipper blogs, in order to properly stir shite, I presume: https://corumproperty.co.uk/wp-content/uploads/2023/05/HomeReport-31.pdf

Armed with my wits and a virtual highlighter, I started to carefully read the whole document. Ownership details aside - this, I discussed yesterday -, I remind you that it should give any prospective buyer a good, detailed idea of the available fittings and current condition of the house put on sale.

In Europe and elsewhere, I guess, inspections of this type are rather a dull and thorough affair. And these people did an excellent job: they checked every single nook & cranny, used binoculars to have a closer look at the roof tiles and listed it all on these papers a good researcher should read, before dropping to conclusions.

This is how we know, for example, that the inspection happened on a rainy day:

.. and that the guttering was overflowing. Does that sound like a well loved, lived-in house to you?

Thought so.

This brought a smile. And the image of a Christmas tree left near a London dustbin in June. Home, sweet home?

Like all properties, this also comes with burglar and fire alarm systems. However, apparently not much has been done, in this respect. Or at least, not recently. Not since February 2022, to be accurate: otherwise, they would have been upgraded. Yet, no such thing: it's up to the buyer to do and pay for the upgrade.

Lived-in? Certainly not after February 2022 and probably even earlier, would be my best guess. But lived-in at some point in time, most certainly.

You see, since I was on the real estate agent's webpage, I also took the virtual tour of the house. It is available to everyone, here: https://my.matterport.com/show/?m=AFKibrk8QiD

Now, I don't know about you, but when I visit somebody's house for the first time, I always check the bookshelves: yes, I am a shameless nerd. I am also well aware that the rest of the furniture was staged, it looked that sad, clinical way it does all over the world. Did not expect to find any books in there, to be honest. And yet, there they were.

I didn't bother with the fashion coffee table books, although I thought they were a nice nod to Ms. B's past, and totally the kind of things she might have on her credenza.

A built-in bookshelf in the basement caught my eye. That did not look staged. It looked as she might have left some of her own books in there, like an afterthought, if you want. And people's choices of books are always speaking volumes to me, about who they really are.

It did not disappoint.

More fash-un. And yeah, Tiffany & Co! I knew it!

A Tina Turner bio or memoir. Awww:

Bette Davis and some feminist literature. Her books, I am pretty sure of that:

And, to save the best for last, lo and behold, what do we have here?

Bear Grylls?

That Bear Grylls?

Hahahaha. Of course. I have all the reasons in the world to believe the music producer/PA/whatever is into masculine thrillers written by a world-renowned survivalist, haven't I?

Not a chance in hell, to be honest. I grinned like the Cheshire cat because, ladies, we do know WHOSE book is this, don't we?

Judging by its jacket, well-read. Not a prop.

Belonging to someone with a dry, wicked sense of humor who apparently also left this gem:

A Captain's Duty. At this point in time, I wasn't grinning anymore. I was laughing like an idiot, of course.

Slàinte mhath, ladies. We'll have time for a proper introduction later.

[cashandprizes]

The Boring CBT Final for the Fun CBT King - By Lexi Moon aka CashAndPrizes

Okay! People asked and I fought tumblr to deliver!

Hi, I'm CashAndPrizes also known as Lexi Moon, and I am a doctoral student studying clinical psychology. I wrote about Redacted (specifically Lasko) for my final for Cognitive Behavioral Therapies. Here's the paper.

Shout out to my beloved friends in the WhoreHome and W.A.R. for keeping me going through this paper. I love you dearly.

Words of warning:

I am a clinician in training. I am still being supervised. I have not been graded on this final yet. (I'll update when I get it!) And I am definitely not an expert. Take everything here with a grain of salt.

I am not a licensed therapist but even if I was I am not your therapist. I'm play acting as Lasko's therapist for a class. Take everything here with a grain of salt. If you read any of this and think "It's a bit loud in here" do not assume this is absolutely you. If you have the means, please try finding your own mental health professionals and if you don't, please do a lot of research on these subjects. Don't use this as a diagnosis please, I'm just a guy.

I filled in a lot of Lasko's backstory based on my experiences with patients and my beloved Lasko kinnies who were instrumental to the writing of this paper. (I won't tag you and call you out, but you know who you are an I love you.) Your headcanons might be different - that's cool. I'm not claiming canon over most of this - but I did use the transcripts and timeline very heavily.

If you don't like the idea of pansexual, transgender, Indo-Caribbean/Trinidadian child of immigrants Lasko - pookie this might not be for you. If that sounds like your jam though - come on in, the water's fine.

Without further ado. Ladies and Gentlemen, this is Mambo Number Five. Here's Lasky. I can, in fact, fix him.

Case Summary

This case conceptualization addresses the hypothetical course of treatment for Lasko Moore, a character in a modern-fantasy audio narrative. Lasko Moore presented to treatment as a 30-year-old pansexual and transgender Indo-Caribbean man working as an administrator and adjunct professor at Dahlia Academy for Magical Novices for persistent anxiety symptoms. Upon intake, Lasko reported experiencing near constant racing thoughts that he was unable to “turn off”, panic attacks, and increased anxiety about social interactions at his work. He described spending a significant amount of mental energy preparing for and reviewing social interactions with colleagues such that he often avoids his colleagues in an effort to minimize his anxiety. Lasko reported that the anticipation around coworker interactions (meetings, socials, etc.) becomes quickly overwhelming as he becomes preoccupied with what he will say and do in an effort to try and minimize his tendency to become hyperverbal and overshare information as well as stuttering. He described this process as starting with embarrassment over previous interactions which leads to critical thoughts like “I shouldn’t be so anxious” which leads to rehearsal of potential outcomes of interactions. However, in the moment of social interactions he becomes so anxious as there “aren’t any objectives [or] any specific roles” to the conversations that he “word vomits” and becomes tangential and overshares until he runs out of breath and stops himself from talking due to his own critical thoughts and begins to isolate himself. 

Lasko was initially diagnosed with Panic Disorder (F41.0) and Generalized Anxiety Disorder (F41.1) to capture his persistent anxious state with occasional intense bouts of extreme anxiety and panic. An initial long-term goal was collaboratively set as improving his coping strategies and tolerance of anxious affect to better network and create relationships. As this was Lasko’s first time utilizing mental health services, treatment began with inhibitory learning in combination with Acceptance and Commitment Therapy in order to facilitate willingness to experience interoceptive cues and extinguish avoidance due to fear of negative consequences. This was able to reduce his panic attacks as he felt more able to tolerate overwhelming anxious affect. Despite his clear engagement with treatment through attendance, homework, and skills practice, Lasko continued to struggle with critical thoughts and avoidance of coworkers which he identified as a major barrier to his continued professional development and potential non-academic relationships. Through collaborative exploration, a persistent early maladaptive schema relating to his critical thoughts emerged and treatment shifted to a goal of starting dialogue between schema modes to facilitate the use of coping strategies to build interpersonal effectiveness. Lasko was born as the human-born child of Trinidadian immigrants who moved the southern California in the early 1990s due to political unrest. From an early age Lasko faced high academic expectations from his parents who desired upward mobility for their child and a “piece of the American Dream.” His mother was emotionally labile to the point of explosive outbursts where his father was more passive and spent significant energy working and caring for his wife. This experience started Lasko’s early maladaptive schema regarding rigid standards with no support, which only became worse when Lasko’s elemental powers began developing at thirteen and his parents expected perfect control (and perfect suppression) of his powers with no training and a highly critical environment. This led to Lasko isolating himself at home as much as possible to hide his lack of control but left him with an environment that created a positive feedback loop where his lack of control led to increased yelling and criticism which led to worsening outbursts of his powers. This culminated in a final traumatic event when Lasko was seventeen and lost control of his powers, leading to his mother “calling [him] everything she could think of […] she was so loud and I just wanted her to stop” to the point that Lasko accidentally sucked all of the air out of the room and almost suffocated his mother. Though Lasko was able to find support with the Department of Uniform Magical Practices and become emancipated from his parents, these experiences developed a maladaptive pattern of hypercritical thinking about himself, especially in the context of social relationships.

Research

Avelino Cardoso et al. (2023) pose potential ways to modify and apply Schema Therapy to sexual and gender minorities. This work focuses on understanding how of harmful implicit and explicit messages about gender and sexuality contribute to early maladaptive schemas based on consideration of the minority stress model, and how Schema Therapy interventions can be applied to sexual and gender minorities. One area of particular relevance from this article is the conceptualization of an inner critic mode that specifically represents stereotypes and prejudice that are naturalized by society. When applying these principles to the case of Lasko, the environment of his childhood can be understood as an essential aspect of the treatment. Though Lasko did not present to treatment looking to discuss the impact of his pansexuality and transgender identity, potentially because of the clinician’s own advertised identities, the impacts of systemic oppression against sexual and gender minorities can be woven into treatment for his hypercritical early maladaptive schema. Based on the suggestions of Avelino Cardoso et al. (2023), it may be worth examining his secondary schemas around shame and social isolation as also being shaped by his experience as a gender and sexual minority and how that may contribute to his predominant hypercritical schema. 

A major concern for this section of the paper is the lack of research modifying second and third wave cognitive behavioral therapies for sexual and gender minorities. Results for Acceptance and Commitment Therapy with LGBTQ+ individuals only revealed one article about group therapy and a study proposal; results for Schema Therapy with LGBTQ+ individuals only provided Avelino Cardoso et al.’s (2023) theoretical essay. There does not appear to be much research and what research exists is extremely limited with no randomized control trials. This makes it clear that evaluating the efficacy of treatment for sexual and gender minorities is not a priority, which leads to a major critique of Avelino Cardoso et al.’s work. Though the article is useful for considering how to address systemic change in the room, it seems to attribute lived experiences of sexual and gender minorities to a schema rather than ongoing threats in a world where hate crimes and discrimination against LGBTQ+ individuals is on the rise. The abandonment and violence that these individuals may face is not imagined and it can be seen in the lack of interest in research.

ADDRESSING Model

When considering the case of Lasko, it is important to remember that psychology does not develop in the vacuum of individual experiences – psychology develops based on the global environment, which includes the social, political, economic, and cultural contexts as well as individual context. Utilizing Hays (2022) ADDRESSING Model, the impact of Lasko’s intersecting identities can be understood to have a major impact on his current symptom presentation and the development of early maladaptive schemas and schema modes. Lasko was born to first generation immigrants from Trinidad with strong Indo-Caribbean and Catholic roots – and he was assigned female sex at birth. Using a systems-focused lens, Lasko’s current symptoms can also be understood within the larger context of living in a world where several aspects of his identity are under intense scrutiny and political debate. As a child of immigrants and as someone Indo-Caribbean, Lasko likely faced explicit and implicit messages about his intellectual capabilities, his body, and his work ethic. While Lasko directly experienced his mother as extremely critical and never satisfied with his performance, it is just as likely that he received messages as a child about needing to work harder than many of his same aged peers for equal amounts of recognition based on his racial, ethnic, and sex assigned at birth. There is also the element of the disconnect between his sex assigned at birth and his gender presentation, and the messages he received about being transgender from his Catholic, Trinidadian immigrant parents as well as the American culture – which were likely discouraging at best and hostile at worst. 

Keeping all of this in mind, Lasko’s hypercritical, social isolated, and emotional deprived schemas can be understood as also being a direct result of the intersection of his identities – and this does not even cover the added layer of being an empowered human-born. In a variety of ways, Lasko has had very different experiences than his peers by virtue of being a transgender, pansexual, child of unempowered human immigrants. When Lasko describes feeling different from the people around him growing up and when he entered the empowered world, this is a real experience based on the multiple identity intersections – it is not hard to believe that he did not have many friends or family members between the late 1990s and late 2000s that had similar experiences to him. This left him with the acute sense that he was fundamentally different and needed to work much harder than those around him, and also that to get validation he needed to sacrifice his needs (or identities) for those of others.

Methodology

The initial treatment approach for Lasko was a combination of Acceptance and Commitment Therapy and inhibitory learning with interoceptive and in vivo exposure, which was successful in decreasing his panic symptoms but not generalized anxiety symptoms. Lasko reported that he experienced sudden panic attacks that seemed random and included symptoms such as accelerated heart rate, tightness in his chest, hyperventilation, feeling that he would lose control, sweaty palms, and loss of control over his magic. At the time of treatment, he reported that he had been having at least one panic attack every other month since he was a teenager and that they would occur more frequently when he was in periods of intense stress. After exploration, Lasko was able to determine that he often had panic attacks related when he spends time ruminating in anticipation of social interactions. Lasko explained that during panic attacks he tends to seek quiet, dark places to hide and “ride out” the panic attack and that he has thoughts like “I’m going to mess this up” or “I can’t do this.” 

Treatment started with Acceptance and Commitment Therapy and inhibitory learning as an evidence-based approach for treating panic attacks and generalized anxiety to address his symptoms and reduce further panic attacks as well as his anxious thought patterns (Barlow, 2021; Ruiz et al, 2020). Acceptance and Commitment Therapy (ACT) is a therapeutic practice that focuses on improving psychological flexibility and understanding the function of behavioral patterns (Gordon & Borushok, 2017). Much of early treatment with Lasko consisted of psychoeducation around the therapeutic process, behavioral therapy, and mindfulness. He took easily to ACT and benefited from understanding how avoiding social interactions was negatively reinforced by decreasing his anxiety while keeping him from creating connection. Inhibitory learning through multiple types of exposure (in-vivo and interoceptive) was able to make him more comfortable with feeling panicked, effectively reducing his panic attacks (Ramnero & Törneke, 2008). However, his baseline anxious affect and negative thoughts did not ease despite the use of ACT, so treatment shifted towards understanding the function of his persistent negative thoughts through Schema Therapy.

Lasko’s symptom presentation after several sessions of ACT and inhibitory learning was a persistent anxious affect and worry (especially around social situations) that felt uncontrollable and critical ruminative thoughts. As it seemed treatment had plateaued, the content of sessions moved towards a deeper understanding of his critical thoughts based on an indication of deeply held early maladaptive schemas. Barlow defines early maladaptive schemas as persistent behavioral, cognitive, and relational themes developed in early childhood that are reinforced throughout lifetime and that cause significant disruption and dysfunction (2021). Schemas are often viewed as truths about the self and others and are difficult to challenge because of the deep affective component and lifetime of reinforcement (Barlow, 2021). Movement towards schema work started with psychoeducation which involved discussing how schemas are reinforced through modeling (in this case by his mother’s critical comments about his performance) and how people can often act in ways that reconfirm schemas into adulthood. Lasko then completed the Young Schema Questionnaire - Revised and received high scores on schemas related to emotional deprivation, social isolation, and unrelenting standards (Rijkeboer, 2015). During the debriefing and explanation of the results, Lasko reported that when he was completing the questionnaire he felt “really seen” in a way that was uncomfortable but also validating to his experiences in childhood and as a queer person of color living in America.

The topic of sessions then moved towards further psychoeducation about the process of schema work, including delving into his schemas and determining schema modes with the goal of improving his understanding of schemas and working towards healthier integration of modes and coping strategies (Barlow, 2021). Lasko was committed to treatment but apprehensive about “what would come up,” speaking to his concerns about dredging up uncomfortable memories and feelings. In response, he was encouraged to revisit his understanding of ACT and his core values as a reminder of why he wanted to continue treatment and work through feelings of discomfort and grief. The next session started proper schema work, starting with Lasko explaining his understanding of schemas and how they were currently impacting him. He aptly summarized that his childhood experience of feeling intense pressure to do well academically and conform to socially and religiously defined gender roles left him feeling isolated from his peers and that he always needed to work harder and do more, while also feeling as though he had no support or anyone who truly understood him – this led to the development of schemas related to emotional unrelenting standards, social isolation, and emotional deprivation. 

The first step of schema work was to identify schema modes as recommended by Barlow (2021). Lasko completed the Young Schema Mode Inventory (YSMI) as homework (along with his regular thought and feeling records) and scored highly in the following modes: vulnerable child, compliant surrenderer, detached self-soother, punitive parent, and demanding parent (Lobbestael, 2015). With this in mind, the next session started with reviewing his thought and emotion records as a baseline for identifying schema modes. Lasko was able to sort different thoughts and feelings into categories that broadly resembled the categories for child modes, coping modes, and parent modes, but he struggled to come up with names for them. He eventually decided on “Young Lasko” to describe his vulnerable child mode, “The Doormat” to describe his compliant surrenderer mode, and “The Critic” to describe his punitive and demanding parent modes with suggestions from the therapist based on his results on the YSMI. Lasko was overwhelmed with sadness and fear during this session, describing how hard it was to name and admit these schemas out loud and how scared and vulnerable he felt. He reported a heavy weight on his chest and how badly he wanted to hide from the therapist and his own internal experience, and his wavering control over his powers was evident by the rustling of papers in the room. The second half of the session was dedicated to using ACT and mindfulness techniques to sit with the almost intolerable affect without judgement. The session closed with a discussion of how he could focus on his value of self-care after the session and he decided that he had plans to meet with his friend group the next day and try to talk with them about his feelings as a form of self-care and confirming his acceptance in his friend group. 

The following session he reported that his conversation with his friend group had gone “really well, better than [he] expected” and the session started by discussing how this did not conform to his expectations as a way to integrate the initial phase of inhibitory learning into the present. The conversation then moved to re-introducing the names for his schema modes and utilizing a combination of mindfulness skills and reaffirmation of his core values to give a voice to those modes and their needs by recommendation of Barlow (2021). Lasko explored that “Little Lasko” felt “awful, awful all the time” and was a sad little boy trapped in a girl’s body who “[held] onto all the bad stuff” including feelings of being completely isolated from others and deep sadness. Lasko further explored that “The Doormat” was a representation of how he had worked so hard in school and at home to make everyone else happy and that by avoiding his own needs and wants (for self-expression, acceptance, nurturance, joy, etc.) he thought he would get his needs met. At this point in treatment, discussing “The Critic” was still too affectively laden so discussion started with the first two with the goal of working up to “The Critic.” Based on guidelines from Barlow (2021), the next few sessions focused on identifying the ways these schemas had developed within his childhood and how they had once been adaptive and essential for his survival. Lasko’s homework between these sessions was to read handouts given by the therapist about schema modes and the ways they are internalized throughout childhood. Lasko was also willing to try journaling once a week from the perspective of either “Little Lasko” or “The Doormat” to better understand how integral they had been to his survival. 

Session Description

This transcript describes the first part of the schema work, where Lasko began to identify and label schemas with prompting from the therapist. Rather than just using the terms from the YSMI, Lasko was encouraged to create his own meaning to better represent his own understanding of the schema modes based on evidence-based methods from Barlow (2021). The goal of this session was to help Lasko observe the schema modes based on his thought and feeling record from the previous week and start thinking of the modes as parts of him that were observable separate from himself.

Therapist: You’ve summed up schemas and how they work, and I don’t even have anything else to add. Lasko: I really, um, want to make sure you know I’m serious about this. I want to get better, I want to be better. Therapist: It feels like it’s really important for you to feel like I know how hard you’re working right now. Lasko: Yeah, well… Yeah, I don’t want you to think I’m not doing the work. Therapist: It’s interesting because you’re the one paying for sessions, you know? While I’m glad that we are working together towards your goals, what you get out of this is really up to you. Can we talk more about how you want to make sure I know you’re working hard? I think that’s really tied to this whole schema thing I’m trying to sell you on. Lasko: I’m already sold on it!  Therapist: [Hm] Lasko: … That’s… that’s what you mean, isn’t it? Therapist: [Affirmative hm] Lasko: Fuck – sorry – shit! I um… I feel like I need to prove to you that I’m listening and trying really hard. Therapist: What will happen if I think you aren’t trying? Lasko: Well, you won’t take me seriously – at all. You’ll think I’m wasting your time and that I should – I need to be doing more and taking it seriously. Therapist: And how would I be feeling with you? Lasko: Angry, because I’m wasting your time – but I’m not, or I don’t want to. I don’t want to waste your time, you have so many other patients you could be seeing and if I’m not doing what I should be doing then I’m just- I’m taking up space someone else could be using and they probably need it more than me. I mean, I’m fine you know, I’m anxious but I can survive, right? There’re people out there who need your time more than me and I’m wasting it – or I would be. I’m not – I don’t think I’m wasting your time right now except I keep rambling. Therapist: There’s a through-line in there that I want to pull. You feel like you need to do what I expect you to do, right? Lasko: Yeah, I mean you’re the therapist. You’re the expert with – all the experience and degrees. So yeah, I should be doing what you expect. Therapist: It sounds like there’s some part of you that feels like you need to be doing what I say you should do, even if you don’t want to or have something else to say – like your “rambling” – and that if you don’t, you’re wasting my time. Does that feel right?

Lasko: I want to do this, I do. But um, yeah. That feels right. Therapist: And you do what I say you should do because if you don’t…? Lasko: Well I’m wasting your time. And then you’ll – I mean you probably won’t, you’re a really nice person and you’re so helpful but I just… I have this thought that you’ll get mad at me. Therapist: I would be mad at you. What would I do if I was mad at you? Lasko: You would um… Well I know you wouldn’t, because you just – you’re not like that but like my mom would start screaming at me. She would just… she would just yell and tell me that I was wasting their money because I wasn’t doing well enough at the school they paid for me to go to you know? Or I messed up the nice clothes they paid for. Or I just – anything like that really, I was wasting money and time and I was a waste of space and… Fuck – sorry – wait, um. This is hard to talk about and I don’t want to cry. Therapist: This is really hard, I’m really putting you through it already today, aren’t I? Lasko: [Affirmative hm] Therapist: I want to take what you just said and kind of summarize, kind of explain, is that okay? So, it sounds like you have these thoughts that you aren’t trying hard enough – or at least that I don’t think you’re trying hard enough, right? And these thoughts serve to make sure that you show me how hard you’re working so that I believe you, because if I don’t, I might think you’re wasting my time and become angry and yell at you.  Lasko: That’s a really succinct way to put it, but yeah. Therapist: So what I think is happening here, is that there’s a part of you that is so terrified that I will become angry and yell at you and make you feel just awful about yourself. And to deal with that, there’s another part of you that works really hard to try and anticipate and meet my needs so I won’t become angry with you. And then there’s also this third part of you, this part that is so critical and reminds you of how scary I could become if I got angry with you and kind of beats me to the punch by being mean first. And all three of these parts were working together in those last few minutes. Lasko: Wow… yeah, that um… you hit the nail right on the head. That feels right. It’s not – um, it’s not really great for me, though. Therapist: What I’d like to do is start by giving a voice to these parts of you, just letting them speak. Do you think we could do that? Lasko: That… That sounds really awful. But, yeah we can… we can do that. Therapist: And here I am, asking you to do these terrible things you don’t want to do and you’re doing them with me anyway.  Lasko: That’s the um.. that part of me that tries to meet your needs, right? That’s what you said? Therapist: I think so. I really want to hear more from that part of you.

At this point in the transcript, the therapist was using a combination of techniques to try and get closer to the schemas that were indicated in Lasko’s dialogue. There was a mix of rephrasing/restating what Lasko had said with the dual purpose of making sure the therapist understood and phrasing things in a way that would lead to more dialogue about schemas. The therapist in this section also started outlining the core schema modes operating at the moment in broad terms to gauge Lasko’s ability to tolerate and explore them further with the intention of eventually moving towards labeling schema modes. In this section, it is becoming clear that Lasko’s persistent anxiety about the therapy (proving he is engaged enough) is a result of active schema modes that attempt to anticipate and meet the therapist’s needs to prevent criticism and anger on the part of the therapist. This insight from the conversation can be broadened to potentially explain the utility of Lasko’s critical thoughts and anxiety around social interactions – he spends so much time preparing and planning for these interactions to try and anticipate and meet the needs of others to prevent criticism and anger from his peers, the mere idea of which causes deep feelings of fear and sadness, by criticizing himself first.

Therapist: I think so. I really want to hear more from that part of you. Lasko: I mean – geez, what should I say? Therapist: Maybe we could start with what that feels like…? Lasko: It feels like I’m always guessing, trying to figure it out. I feel like I have to do everything right, try harder, do more…I feel like I always need to be doing more, doing it better. Therapist: What emotions does this part of you have? Lasko: Um, I don’t – I don’t know.  Therapist: Do you think I should bring out your old friend the feelings wheel? Lasko: Yeah that might – might help. You know how much I love the wheel. Yeah – um, I guess I feel… inadequate? Maybe… Therapist: Can I suggest something that I’m sensing in you? Lasko: Please, you’re way better at this than me. Therapist: I’m wondering if this part of you feels desperate. Lasko: Yes, desperate. Therapist: Desperate… it feels like there’s more to that. Desperate for what, do you think? Lasko: Desperate… desperate to please – desperate to get it right. Therapist: Wow… desperate to please feels really powerful. I see you rubbing your chest right now, what are you feeling? Lasko: It’s like… my chest feels tight – a little like when I have panic attacks. Therapist: That connection feels really important. What do you make of that? Lasko: I feel – I’ve felt desperate when I’ve had panic attacks before. Like desperate for air, which is just – it’s funny as an air elemental you know, well not funny-funny, but it’s just – anyway, it’s like desperate for air but it’s also like I’m desperate for… I don’t know how to phrase it…? For it to stop, yeah, but also like I… I want to do things right when I talk to people but I always fuck it up – sorry – wait, don’t apologize Lasko. Sorry, I – sorry – fuck. I just- I want to have better interactions with people! I want things to go better and to communicate better so people like me and – I don’t know. Therapist: So people like you… do you think that’s what this part of you wants? Lasko: Yes – so badly… So badly it hurts. Therapist: It hurts in your chest, right there? Lasko: Yeah… it’s tight and heavy and then I start crying because I’m just – I’m a mess. Therapist: You’re feeling so much right now, and you’re doing it because I said we should. Lasko: Well… yeah, it’s um – it sucks but you know better than me. Therapist: That seems to be a thought you have a lot, we’ve talked about it before on your thought and emotion records – and I think it’s really tied to this part of you. Lasko: I mean… maybe, yeah. Therapist: What do you think you could name this part? How do you think we could refer to it? Lasko: Like a name? What kind of name…? Therapist: It’s really up to you, I think it’ll be more helpful to use whatever you think is the best way to describe it rather than my clinical-ese jargon.  Lasko: I don’t… I don’t really know. I’m not good at this kind of thing. Can’t you – you can just name it, right? Therapist: I could, but I feel like if I name it we’re staying in this pattern where you just acquiesce to my demands. Lasko: Which is like – the whole point of this, yeah. Therapist: Exactly. What feels hard about thinking of a name? Lasko: I don’t – I don’t want to pick some stupid name that I have to use, and you’ll think “wow that was a really stupid name choice, I should have picked it.” Therapist: [Hm] Lasko: Yeah, you don’t have to say anything, I hear it. Also, I just… naming it feels so real, you know? Then it’s a real thing. Therapist: And there’s something about it being “a real thing” then? Lasko: Then I’d… I’d have to talk about – acknowledging all of it – that feels really awful. I feel like I can’t breathe right now. Therapist: I can feel the air becoming thin too. Why don’t we take a few moments and just notice how you’re feeling and breathe through it?

This section of the transcript starts to explore and move towards labeling the schema mode of the Compliant Surrenderer. This mode attempts to anticipate and meet the needs of his hypercritical Punitive and Demanding Parent mode to protect his Vulnerable Child mode, which becomes clear in the transcript as he verbalizes that this part of himself is desperate to do well (whatever that may look like) so that others will like him. Just sitting with this part of himself causes Lasko almost intolerable feelings of desperation and panic, likely due to his fear of his Punitive and Demanding Parent mode as well as a fear of criticism and rejection from the therapist.

Closing Thoughts

I really enjoyed this case and this paper. While I didn't choose a current patient, I feel that I got a lot out of this assignment. It was really interesting to think formally about a character and work through a treatment plan and focus on a specific element of treatment. I managed to pick a case where I got to implement schema therapy, which is one of the forms of CBT that I find most interesting in addition to ACT. Despite this being a fictional character, I have certainly had previous patients who have similar struggles – and I also felt that I was able to use the media (and my previous experience to fill in gaps) to make the most of this assignment for my learning.

As I was working on this case, it occurred to me that though I felt like I was able to portray this character as accurately as possible I felt like so much was missing or unaccounted for. Because I was working from a CBT rather than psychodynamic lens, I felt like there were clear points where I would have ideally worked more relationally to address resistance or spoken more about the therapeutic relationship. There are always a million different things you could pick out of a patient’s response to respond to, and it was challenging to focus more on the schemas rather than talk about the relationship. I also felt like because of the limits of this paper, I did not have enough space to talk in the methodology or transcript session about how I felt his identities played a part in the development of his schemas. In this example, it was very clear to me that Lasko’s experiences of his parents were only part of the equation as development does not exist in a vacuum – there is a reality that his identity as a pansexual, transgender, Indo-Caribbean, second-generation immigrant and his experiences of xenophobia, racism, heterosexism, and transphobia would have also impacted his feelings of isolation/difference from others and internalized pressure to present and perform well. I also think that this would have been something I discussed in subsequent sessions as I believe this is another function of his schemas – to protect and prepare himself from his experiences of a hostile, sometimes violent world.

References

Avelino Cardoso, B. L., Paim, K., Figueiredo Catelan, R., & Liebross, E. H. (2023). Minority stress and the inner critic/oppressive sociocultural schema mode among sexual and gender minorities. Current Psychology, 42(23), 19991–19999. https://doi.org/10.1007/s12144-022-03086-y 

Barlow, D. H. (2021). Clinical handbook of psychological disorders: a step-by-step treatment manual. Sixth edition. New York, The Guilford Press.

Hays, P. A. (2022). Addressing Cultural Complexities in Counseling and Clinical Practice: An Intersectional Approach. Fourth edition. Washington DC: American Psychological Association.

Lobbestael, J. (2015). Validation of the Schema Mode Inventory. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley‐Blackwell Handbook of Schema Therapy: Theory, Research, and Practice (pp. 541–552). Wiley-Blackwell. 

Ramnero, J., & Törneke, N. (2008). ABCs of human behavior: Behavioral principles for the practicing clinician. Oakland, CA: New Harbinger & Reno, NV: Context Press.

Rijkeboer, Marleen (2015). Validation of the Young Schema Questionnaire. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley‐Blackwell Handbook of Schema Therapy: Theory, Research, and Practice (pp. 531-540). Wiley-Blackwell. 

Ruiz, F. J., Luciano, C., Flórez, C. L., Suárez-Falcón, J. C., & Cardona-Betancourt, V. (2020). A multiple-baseline evaluation of acceptance and commitment therapy focused on repetitive negative thinking for comorbid generalized anxiety disorder and depression. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00356 

Home. (n.d.). Redacted Audio. Retrieved May 5, 2024, from https://redacted-audio.com/

Appendix

Character and Media Primer

Redacted Audio is an urban-fantasy audio narrative on YouTube that centers around the fictional city of Dahlia in southern California and its inhabitants (“Home”, n.d.). In this urban-fantasy world, people are separated into four categories: unempowered humans; empowered humans, which can be further broken down into elementals and energetics (people with control over the four elements, gravity, sound waves, magnetics, psychokinesis, telepathy, seers, or a jack of all trades) and shifters (e.g.: werewolves); vampires, who are turned unempowered or empowered humans that feed on blood to survive, have superhuman speed and senses, and cannot go out in the sun; and demons, beings of pure magic that are not necessarily evil or good. The character I have chosen is an empowered human who was born to unempowered human parents – a human-born – which is a rare kind of person who often faces discrimination and barriers to learning how to control their magic. Lasko is an administrator and adjunct faculty member at the Dahlia Academy of Magical Novices, which is essentially magical community college where students (of any age) can learn mastery over either their specialty or all aspects of empowered human magic. The Dahlia Academy of Magical Novices operates as a school under the larger Department of Uniform Magical Practices, which oversees magical practices, ethics, and maintains the covert status of magic. Lasko specifically has natural control over the element of air, giving him an increased lung capacity and control over air (making wind currents, taking air out of the room, making tornados, etc. – think air benders in Avatar: The Last Airbender if you are familiar), but chose to complete his full certification at The Dahlia Academy of Magical Novices to have a better understanding of all types of magic. He teaches an introductory class on magic for incoming students as a way to provide a less discriminatory experience for other human born students.

ACT Hexaflex

YSQ-R Table

YSMI Table

That's all, folks!

[croservices]

How To Learn CLINICAL RESEARCH ORGANIZATION NEAR ME

1. What is a Clinical Research Organization?

A clinical research organization (CRO) is a research-based organization that provides services to pharmaceutical and biotechnology companies to help them develop new drugs and medical devices. CROs offer a wide range of services, from pre-clinical research to clinical trials and post-marketing surveillance.

CROs emerged in the early 1980s as a response to the growing cost of drug development. Pharmaceutical companies began outsourcing clinical research to CROs in order to save money and time. CROs are now an integral part of the drug development process, and their services are in high demand.

There are many reasons why pharmaceutical and biotechnology companies choose to outsource their clinical research to CROs. CROs have expertise in all aspects of clinical research, from study design to data management. CROs also have access to a large pool of patients and investigators, which speeds up the clinical trial process. In addition, CROs are often more cost-effective than conducting clinical research in-house.

The global CRO market is expected to grow from $32.9 billion in 2016 to $43.8 billion by 2021, at a compound annual growth rate (CAGR) of 5.9%. The growth of the CRO market is driven by the increasing demand for outsourced clinical research services, the need to reduce the cost of drug development, and the shortened timelines for drug development.

CROs provide a wide range of services to pharmaceutical and biotechnology companies. The most common services provided by CROs are clinical trial management, data management, and biostatistics. Other services offered by CROs include regulatory affairs, project management, and medical writing.

Clinical trial management is the process of designing, conducting, and monitoring clinical trials. Clinical trial management includes all aspects of the clinical trial process, from protocol development to patient recruitment to data management.

Data management is the process of collecting, storing, and analyzing clinical trial data. Data management includes data entry, data cleaning, and data analysis.

Biostatistics is the science of designing and analyzing clinical trials. Biostatistics includes the development of statistical methods for data analysis, the design of clinical trials, and the analysis of clinical trial Clinical research organization near me

2. What do Clinical Research Organizations do?

Clinical research organizations (CROs) are companies that provide support to pharmaceutical and biotechnology companies in the development of new drugs and therapies. CROs offer a variety of services, including clinical trial management, data management, and biostatistical analysis. CROs are an important part of the drug development process, as they provide the expertise and resources needed to conduct clinical trials efficiently and effectively.

CROs manage all aspects of clinical trials, from start to finish. This includes developing the protocol, recruiting and enrolling patients, collecting and managing data, and analyzing the results. CROs also play an important role in ensuring that trials are conducted ethically and in compliance with all applicable regulations.

Data management is a critical component of clinical trials. CROs are responsible for ensuring that data is collected accurately and consistently, and that it is properly stored and organized. Data management includes activities such as patient recruitment, case report form design, data entry, and data cleaning.

Biostatistical analysis is another key service provided by CROs. This analysis is used to interpret the data collected during a clinical trial and to assess the efficacy of the experimental treatment. Biostatistical analysis is a complex process that requires a deep understanding of statistics and data analysis.

CROs play a vital role in the drug development process. Without CROs, many new drugs and therapies would never make it to market. CROs provide the expertise and resources needed to conduct clinical trials efficiently and effectively.

3. How can I find a Clinical Research Organization near me?

Clinical research organizations (CROs) are companies that provide services to support clinical research. These services can include conducting clinical trials, managing patient data, and providing regulatory compliance support. Many CROs also offer consulting services to help sponsors develop clinical research protocols and navigate the regulatory landscape.

CROs can be a helpful partner for companies and organizations that don't have the internal resources to conduct clinical research themselves. CROs can also be a good option for companies that want to outsource some or all of the clinical research process.

There are a number of ways to find a CRO that's a good fit for your needs. You can start by doing a search online or asking for recommendations from colleagues or other organizations that have conducted clinical research. Once you have a list of potential CROs, you can narrow your search by considering factors such as location, size, and areas of expertise.

It's also important to consider the culture and values of a CRO when making your decision. Some CROs are more hands-on and involved in the day-to-day conduct of a clinical trial, while others take a more consultative approach. There's no right or wrong answer here - it's important to find a CRO whose culture and values align with your own.

Once you've narrowed down your list of potential CROs, it's time to start reaching out and requesting proposals. This process will give you a chance to learn more about each CRO and get a sense of their capabilities and expertise. It's also a good opportunity to ask questions and get a feel for the CRO's communication style and customer service.

Choosing a CRO is a big decision, but it doesn't have to be overwhelming. By taking the time to do your research and ask the right questions, you can find a CRO that's a good fit for your needs and your company.

4. What are the benefits of working with a Clinical Research Organization?

A clinical research organization (CRO) is a company that provides support to pharmaceutical and biotechnology companies in the form of research services outsourced on a contract basis. A CRO can be small or large, with a global reach. Typically, a CRO will have a staff of scientists with expertise in various therapeutic areas who can provide support in the design and execution of clinical trials, as well as data analysis and interpretation.

The benefits of working with a CRO include access to experienced staff, economies of scale, and flexibility. For small or early-stage companies, working with a CRO can be a cost-effective way to get started in clinical research without having to build up an internal infrastructure. For larger companies, working with a CRO can provide flexibility in terms of staffing and capacity.

In terms of experienced staff, a CRO can provide access to scientists with a wide range of expertise and experience in clinical research. This can be especially helpful for small or early-stage companies that may not have the internal resources to support a clinical trial. In addition, a CRO can provide economies of scale in terms of both personnel and resources. By working with a CRO, companies can avoid the fixed costs associated with maintaining an internal clinical research staff.

Finally, working with a CRO can provide companies with flexibility in terms of both staffing and capacity. CROs typically have a large pool of personnel with various skills and levels of experience. This allows companies to staff a clinical trial quickly and easily, without having to commit to a long-term employment relationship. In addition, CROs often have excess capacity that can be used to support spikes in demand or unexpected delays.

Overall, working with a CRO can be a cost-effective and flexible way to conduct clinical research. CROs can provide access to experienced staff, economies of scale, and flexibility in terms of staffing and capacity.

5. How can I get started with a Clinical Research Organization?

A clinical research organization (CRO) is a company that provides support to pharmaceutical and biotechnology companies in the form of research services outsourced on a contract basis. Clinical research organizations conduct and manage clinical trials on behalf of their clients, providing a turnkey solution that can save time and money.

There are many ways to get started with a CRO. The most important thing is to find a CRO that is a good fit for your needs. There are a number of factors to consider, such as size, geographic location, areas of expertise, and reputation.

Once you have narrowed down your options, you can contact the CROs to get more information and to discuss your project. Many CROs have websites that provide detailed information about their services and how to get started.

The best way to learn about a CRO is to talk to someone who has worked with them before. Ask for referrals from your network of colleagues, friends, and family. Once you have a few names, you can research the CROs online and read reviews from past clients.

When you are ready to take the next step, the best way to get started is to contact the CRO and set up a meeting. This will give you a chance to learn more about the CRO, their services, and to ask any questions you may have. After meeting with a few different CROs, you will be able to make an informed decision about which one is the best fit for your needs.

[rey-jake-therapist]

You know, Sauron gets called a narcissist a lot and we should talk about it a bit. The thing is, from someone who's read books, watched films, and done tons of info gathering all because I lived with a narcissistic parent, it's surprisingly to me how so many ppl only look at his tendencies from an angle of victimhood (but understandable), and not the angle that if you're cunning enough, you can play the reverse uno card on their dumb asses. I lived in emotional pain for years until I realized I decided to accept the role of victim, and that I didn't have to. So I decided to research everything about narcissists, and found psychological ways to play them at their own game by taking advantage of their blind spots.

For one, since they have this inflated sense of grandiosity, they find it very hard to believe a lie that flatters their ego. Idk if ppl realize this. Because denying a compliment with /some/ truth in it would mean they are being humble, and thus downplay this false image they desperately want others to believe about them (unless they're faking humility for reason, like to get a promotion or to flatter themselves to someone above them on the ladder, or in Gals case, because he thinks it would look good on him in her eyes to appear 'humble'), as well as admitting to that egoistic part of themselves that they aren't as great as they believe they are (and they do). Like I said how I lived with a narcissistic parent? I figured out that if I pretend to hype them up when they're in a good mood, they would genuinely think I cared about them and thought they were this amazing dad, and they would be like 'hey let's go get some mcdonalds!' It was nothing like the genuine love from a nonnarcisstic dad, but I learned how to manipulate him to get things that I wanted, simply by playing to his need for admiration and validation.

I'm not saying this tactic works for every narc you come across, but if you can get yourself into their head, be the master to their puppet strings, instead of opposing them or correcting them (they hate criticism and anything that hurts their ego, as we see with Annatar), you can use them just as they see you as a tool.

Idk if any of this makes sense. I do think that I may have absorbed some of my dad's traits for seeing things this way, but I know in my heart I would never ever treat my own kid like this. I see it as a form of adaptation to living with someone with such a vile personality disorder. But in terms of Sauron, he's got to be one of the dumbest narcissists I've seen. He is praised for his masterful deceit and manipulation but he's genuinely stupid in that he doesn't have the self awareness (like the audience, particularly haladriels) to realize that Galadriel is a huge blindspot for him in everything.

I'm not JRRT and I can never hope to write anything near the world he built, but if the forces of good have any brain they would take advantage of this blindspot in some way instead of furiously kicking against the current and thus causing a lot of bloodshed and losses for their own side.

I hope you don't mind if I copy/paste your second message here since it's the continuation of this one... It avoids that I make two different posts :)

And also, just to add to my last ask: And this is why I think Gal jumped off the cliff. She still has some sort of emotional entanglement with this whole mess, which is a HUGE RISK if she were to try to play him at his own game (at this point). It's one thing to completely divorce any kind if feeling between me and my narc dad, who I've lived with for years, and slowly realized that he would never be the dad I am owed. It took a lot of pain and tears when I finally realized it (Dont feel sorry for me, I'm not even emotional about this anymore, I just see our past in this clinical detached way. I find narcs fascinating in same way a scientist studies a lab rat). But for Galadriel, her situation is different. She didn't have years by his side to slowly realize this. To slowly pick apart and coldly analyze Sauron's pattern of action, thoughts, and habits like I did with my own dad. Her feelings at that meeting were raw and unorganized, she was angry, more emotionally betrayed, unable to stop galloping until the very end, when she stumbled upon a last ditch idea (really it was a gamble) to get away as far as she can from him. Idk if its because of the crown wound or her own resolve that she fears is weakening her, but she needed distance asap. But I really think my idea is interesting and I hope to see more fics in the future that take on Galadriel using herself as his blindspot to weaken him. It doesn't have to he canon compliant, but it would also play well into how canon ends. Just some interesting food for thought. A lot of fics I see are pwp and redemption focused, which I already love, but I also kind of want to see them become like chess masters as manipulation. Gal in particular has so much potential and we know she has a very vindictive dark side. ;)

I know you said you said there was no need to feel sorry for you, and I actually admire your strength of character, but I still want to say this : no kid should have to suffer from having narcissist parents. I myself lived with a narcissist for years, so I know where you come from, even if it was of course a different dynamic. And you're right about not accepting to be a victim ! It's very hard, because it involves accepting that you deserve better, something that a narcissist will constantly make sure you don't. Needless to say that the Annatar/Celebrimbor relationship was very hard for me to stomach, because of the way Annatar behaved towards Celebrimbor. It felt very familiar, and I really didn't like it. I'm worried about my kid now, especially after reading your post... I'm worried about how my ex's behavior will affect him. Hopefully, I am able to balance things out. I'm a lot of things, but I'm damn sure I'm not a narcissist.

I won't comment the rest of your post, not because I'm not interested, but for the exact opposite reason : I couldn't add anything smart or relevant to what you suggested for the Haladriel dynamic :) Thank you for sharing these ideas with me !

[beemoon17]

Just want to write a bit about my experience with the whole starting testosterone process in PA. I have had a really great experience and I really hope this can help other trans people to feel more confident going into this process.

I’ve been out since I was in 4th grade and this year I started the process to go on t. I made an appointment with my regular doctor, just a “well checkup” and spoke to her about my desire to start testosterone. She was incredible, no invasive questions, she was respectful of my desires, spoke to me about some options she was aware of and recognized that she didn’t known enough. I went home, she did her research, and she made me a referral to a gender clinic near me within the week.

My mom called the gender clinic for me, they put me into their system and said I’d get a call within 2 weeks to schedule a therapy appointment. The therapist would be the one to give me a referral to the medical doctor at their clinic. They called us back within 2 days NOT weeks. And much to my joy and disbelief there wasn’t the wait list I expected. My appointment with the therapist was going to be the very next week.

Today I went to the therapist. She was the most queer informed cis het individual I have ever met. She was understanding of and knowledgable about not just the medical and psychological side of being trans and queer, but also of the culture and media. She didn’t make judgements of my competency based off of my past mental health experiences or my autism. It was the first time I ever felt understood by or seen by a therapist or health professional. She was non-invasive, her questions were respectful, her understanding of gender and transition as existing outside of just a “hatred” for one’s body and as a range of experiences in and outside the binary was beautiful. At the end of the appointment after speaking to me and my mom she had decided to give me the go ahead for the medical doctor in order to receive testosterone. Once again I was surprised: I had faced no ignorance from the therapist, there weren’t a million more appointments for me to attend, or months of begging for something I have clearly and consistently wanted for years of my life.

When I went to the front desk to make the appointment I once again expected some disappointment or an obstacle. Perhaps a months or even a year long wait to see the medical doctor, after all everything had gone so well so far, surely there would be an obstacle here. But no, my appointment was scheduled for the 4th of this upcoming month, 12 days from today. Not even 2 weeks. On that day I will more likely than not receive my prescription for my testosterone.

I am so full of joy and hope with this experience. For the first time in my life I feel like my future is real, like my life will be fully mine. I feel confident and full of anticipation for the future. And I’m so touched by the understanding and support from the medical professionals I’ve worked with to get to this point, who have worked so hard to be understanding and inclusive and kind. I understand my privilege here, I’ve read the horror stories, I know how so many people struggle, and I feel deeply in my heart for everyone in our community who has been met with barriers and ignorance and fear in their journeys to medically transition. But I hope that my story can spread some joy and hope for others, and maybe alleviate some fear for some. Sometimes, as rare as it is, we do get breaks, things do get to be easy and kind for us, and with the way things have gone in this country the last several years I’ve needed proof of that so much more than ever.

I’m looking forward to sharing more of my journey with medically transitioning! I’m happy to answer any questions about the process to getting there, what my therapy session looked like, and going forward about the physical and mental changes testosterone causes!

[prolifeproliberty]

What would be your response to the pro-abortion argument that Crisis Pregnancy Centers falsely advertise themselves as medical centers, that they spread diseases, that they harass women, and that there should be more government oversight of those clinics and that they should be more transparent with how they use government money?

I made a pro life post recently and the pro-choicers and pro-abortionists are all over the whole supporting crisis pregnancy centers thing.

1. “Pregnancy centers falsely advertise as medical centers.”

Ask for examples. Ask them to show you a website or ad for a pregnancy center that says or implies they’re a medical center. Then check what services that center offers - many pregnancy centers do offer medical services!

This is where the confusion occurs - pregnancy centers are not all the same. Some are more “resource centers” that provide counseling, classes, material support like disappears and formula, and so on.

Others are more medical, and might offer ultrasounds and early prenatal care, along with annual well-woman exams, STD testing, and so on. These facilities usually have nurses and physician assistants, and sometimes have OB/Gyns who volunteer part-time. Almost all pregnancy centers offer pregnancy tests.

This is a good time to remind everyone that ALL pro-lifers should be familiar with the pregnancy centers in their area! Go to OptionLine.org and scroll down to “Find a Center Near You”. Put your zip code in the search. You’ll get a map view and a list of all the pregnancy centers registered with OptionLine (which will be most of them - you can also check CareNet’s directory to make sure you aren’t missing any)

You should know:

- Which center is closest to you

- Which centers offer pregnancy tests and ultrasounds

- Which (if any) offer STD testing and other gynecology services like well-woman exams

- Which offer things like diapers and formula

Bonus points: Call one or more of the centers and ask for a tour. Tell them you’re a pro-life advocate and you want to be more familiar with the pregnancy centers around you. They’re often more than willing to show you around! Meeting the staff and seeing the facility can really help if someone asks you where to find pregnancy help. There’s a big difference between “let me google that really quick” and “oh just go to ____ pregnancy center, the staff there are great and they offer [whatever services they offer]”

2. “Pregnancy centers spread diseases” Again, ask for evidence.

There used to be a great website that published abortion facility health inspections, but it appears to be deactivated. But if you google “Abortion clinic fails health inspection” (without the quotes) you’ll get multiple stories of abortion facilities in different states that failed their inspections over the last several years.

3. “They harass women”

Evidence, evidence, evidence. Pregnancy centers usually aren’t cold-calling. Women choose to go to them for help. Sidewalk advocates outside abortion facilities may direct women to the pregnancy centers, but they usually don’t work for the centers or represent them in an official capacity. And even then, sidewalk advocates usually aren’t harassing anyone. Standing outside an abortion facility and offering information is not harassment. So the person making this claim needs to provide evidence of pregnancy centers “harassing” women and define what they mean by harassment.

4. Oversight/use of government money:

The pregnancy centers I know and have researched all publish detailed financial reports. They rely on donors much more than they do the government, and they need to be transparent to maintain donors’ trust. So again, I would need an example of pregnancy centers that take government money AND don’t publish annual financial reports that show what they’re doing with the money.

When in doubt, ask the person who is making the claim to support it with evidence. If they can’t/won’t, you can dismiss them and their claims.

[flyonthewallmedstudent]

Q Fever

Aka, Query fever. What a weird name for a disease. Imagine telling people that's what you got.

in the 30s-40s, an Australian pathologist in QLD/Brisbane, came across an outbreak of the same or similar illness among abbatoir or slaughterhouse workers.

At the time, he called the disease "Q" fever or query as a temporary name until the pathogen could be identified. Unfortunately it stuck.

decades later, now nobel prize winner and virologist, MacFarlane Burnett isolated and identified the microbe responsible. I think this discovery contributed to his prize. i forget already.

Microbe responsible: Coxiella burnetti. Named for Burnett and HR Cox, the American bacteriologist who found the genus Coxiella where C burnetti falls under.

Initially they felt it was related to Rickettsia, responsible for Rocky Mountain Spotted Fever, but as science progressed, this was disproven.

Now for a Case Report

A 55 yo Italian man with a history of aortic valve replacement was diagnosed with pyrexia of unknown origin twice. Further signs included myalgias/splenomegaly/night sweats. The 2nd time he was admitted for PUO he deteriorated rather dramatically and was put on meropenem and teicoplanin.

A host of organisms was tested for on serological testing based on the man's travel and epidemiological history, all negative. Even a rheumatological panel was done, also less revealing. He also had a history of MGUS (a haem disoder), which is kind of a red herring here.

Cultures were negative, no vegetations were seen on a TTE - so they did consider IE. Which is an important differential for PUO.

Eventually a PET-CT was done (often favoured when investigations do not yield much for a sick patient with fevers), finally revealing a focus of infectious on his ascending aorta, where he'd also had previous surgery done. And in a round about way, they also further identified Coxiella Burnetti. He was treated doxycycline and hydroxychloroquine. As it's so rare in Italy, it wasn't really considered even though he mentioned rural travel.

Bottomline: Q Fever is an important consideration in the work up for culture negative IE. Further to this, always consider IE in the differentials for PUO particularly if they're at increased risk for IE (prosthetic valves, damaged valves, select congenital heart issues, previous IE). IE can present with night sweats, fevers, weight loss and splenomegaly. It can be insidious and chronic in nature. other risk factors can be more suggestive as we'll get into below.

Causative organism

Coxiella burnetti, it's a zoonoses - i.e. transmissible from animals. Special powers: very tough/hardy, can survive extreme environments (high temps and UV light etc.) over prolonged periods and is resistant to many common disinfectants/surface cleaners.

It's an intracellular pathogen and gram negative coccobacilli (PINK!)

name coccobaccili reminds me of cocopuffs.

it's mainly associated with farm animals, which the CDC so wholesomely displays on its website on Q fever (wtf).

goats, sheep, cattle typically (but many other animals, even birds, dogs and horses can be reservoirs)

in particular bodily fluids - amniotic fluid, placenta, faeces/urine, milk etc.

you can get it through unpasteurized milk and through inhaling it if it lands on dust in the area

ever visit a farm or petting zoo lately? OMG WASH YOU HANDS.

That said, it's typically inhaled in inorganic dust. You inhale it, it goes to the lungs, and then the bloodstream.

Increased risk for Coxiella burnetti (What to take on history of exposures and when to strongly consider it)

live on a farm or near one

exposure to a farm

work as a vet on a farm

farm worker, dairy workers, researchers on these animals/facilities

slaughterhouse/abbatoir

Also from CDC:

Clinical presentation

Most won't get sick after exposure and remain asymptomatic, a very small minority does. even though it is highly infectious.

incubation time is 2-3 weeks (consider this time in your history of exposure, did they work on the farm 2-3 weeks ago as opposed to yesterday).

Nonspecific acute infectious symptoms:

nonspecific systemic fevers/malaise/arthralgias/myalgias--> key is high fevers though and can be associated with headache and photophobia.

non specific GI - N/V/diarrhoea

respiratory ones - SOB or cough, consider it as atypical cause of community acquired pneumonia.

rare: hepatitis and jaundice (granulomatous) or encephalitis with neurological complications such as demyelinating disease or CN palsies, also haemolytic anaemia and HLH (yikes)

really it's the history of exposure that will lead you down the garden path to Q fever.

Chronic Q fever is perhaps worse, and can present as culture negative IE/PUO. Months/years later, as B symptoms as above above + LOW/LOA, night sweats. More likely to occur if you are predisposed for IE as above, have a weakened immune system for any reason, including pregnancy.

Chronic Q fever has a mortality of 10% if left untreated. About <5% of those with acute Q fever develop this if left untreated. Speculation is that it's more of an autoimmune process or abnormal immunological response to the bacteria.

To be honest, most who walk in the door with community acquired pneumonia get treated empirically for atypicals anyway, (standard course of doxycycline), so we hardly really ponder the question of Q fever in every patient. But if they present chronically and did not have atypical cover at the onset of acute symptoms, then it's something important to consider.

Other important conditions - can cause complications in pregnant women and 20% will get post Q fever syndrome. like chronic fatigue.

investigations

Serology! nice and easy. Look for IgG antibodies in the chronic presentation. Or PCR. Down side to serology - can take 2-3 days for the body to make said antibodies to the bacteria for detection. PCR can be done on any fluids/tissue sent.

Cultures useless, hence it fall under the umbrella of culture negative (hard to grow outside a host cell, it is an obligate intracellular pathogen).

Other hints on bloods (as serology/PCR takes time to return) - elevated or low platelet's, transaminitis with normal bili, opacities in CXR with hilar lymphadenopathy, CSF will show raised protein levels if done when encephalitis is suspected.

imaging can also support the diagnosis.. as illustrated by the case report.

Treatment

Acute disease - as standard for atypical bugs, doxycycline 100 mg BD for 14 days. Alternatives - TMP SMX or Clarithromycin.

Chronic Q fever or IE:

native valves: doxycycline and hydroxychloroquine (200 TDS) for 18 months

prosthetic: same but 24 months

why hydroxy: enhances the action of doxycycline (increases the pH of the phagolysosome)

Follow-up: look for 4 fold decrease in IGG

Sources:

CDC

Stat Pearls

Wiki as linked above