#It was right before my Addison's diagnosis and I was really sick at the time and I didn't know

[once-delight]

oh that feel when one of your favourite songs by your favourite musical artist only exist as a single bootleg posted 16 years ago and a good amount of the lyrics are ineligible because of the recording quality 🥲

completely unrelated, here's Old Apollo by Alex Reed

[amelialincoln]

sentence prompt “i’m gonna throw up” said by amelia

if you ever see this thx!

“You ready?” Amelia called into the living room, her mouth full of apples. “Do you want me to grab you something for the road?”

“I’m good,” Link replied as he entered the kitchen.

“You’re nervous,” She stated, eyeing his unsettled demeanor.

“Am not.” He looked up at her with a teasing grin before swallowing worriedly. “Should I be?”

Amelia laughed, tossing him a protein bar. “You’ll be fine. The lecture rooms are always packed for me since I operated on Nicole. I doubt anyone will show up to yours,” she teased.

“It’s mandatory for interns and residents,” he grumbled, taking a bite out of the protein bar. “This whole presentation thing is dumb. If I was an intern or resident I wouldn’t want to sit through a presentation given by every attending in the hospital.” “Not every attending,” Amelia corrected with a smile.

“I don’t know how you got out of this!” Link’s exasperated tone made her laugh.

“I’ve done my time presenting. I have actual surgeries to perform.” She grinned at him jokingly before grabbing the car keys and turning the knob to their apartment.

“Babe?”

“Yeah?” Amelia turned to find him holding a small syringe with a sympathetic smile and groaned.

She felt bad for missing Link’s presentation, which had apparently gone well. He was grinning from ear to ear when he sat down at the table for lunch.

“Someone’s happy.”

“It went well,” he stated, his face flushed with pride. “Since Nico left I need more residents interested in ortho.”

“I have mine this afternoon.” Alex chimed in, biting into his sandwich with resentment. “Bailey finally forced me to do one. I could be doing a pancreatectomy with Mer today instead but no.”

“Just skip it, I doubt anyone will care.” Meredith shrugged, pushing a strand of hair behind her ear as she jots something down in a notebook.

“It’s not like you’ll be missing me,” Alex grinned. “You get to operate with your boyfriend now.”

“Alex.” Meredith warned, glancing up from what she was studying. “We’re not in highschool.”

“Then stop acting like it. You can’t keep your hands off eachoth--”

“That’s it I’m leaving.” She packs up her notes, trying to keep a smile off her face.

“Tell Cormac I say hi,” Alex calls, using his first name for extra impact. Meredith glares at him.

“Alex,” Jo scolds, grabbing a piece of his sandwich and popping it into her mouth. “Stop being a dick.

“She’s happy,” he grins. “She likes him.”

Jo lets out an exasperated sigh and rolls her eyes. “Are you guys watching any of the presentations today?” Amelia and Link both shook their heads. “I didn’t plan on it but the rest of my day is free so I wouldn’t mind,” Amelia shrugs.

“I’m not operating until tonight,” Link agrees. “Do you know who’s presenting?” “Other than this idiot?” Jo teases. Alex throws bits of food in Jo’s direction. “You’re a child.”

“Am not,” Alex huffs.

“I know Carina’s in a half hour and Koracick is later tonight. Other than that I’m not sure,” Jo answers.

“I wouldn’t mind seeing Carina’s, she usually has something interesting going on,” Link offers.

“Oh really?” Amelia taunts.

“You shouldn’t be the one to talk,” Alex coughs, receiving a glare from Amelia and a confused look from Link. “Sorry, I’m leaving,” He chuckles.

“Hey,” Jo greeted Amelia and Link as she and Alex took seats beside them. Carina was setting up her computer and the room was buzzing with interns and residents. “Not a lot of navy scrubs.”

“Nope,” Amelia shrugged. “I guess everyone else actually has stuff to do.”

“This is stuff,” Link argued. “We’re educating ourselves.” “Right,” Alex nodded sarcastically. “You guys wake me up when it's my turn.”

“Where’s your laptop?” Jo inquired.

“I’m taking the improvisation route,” he replied. “Hey, the interns love me.” He justified himself to Jo’s unimpressed expression. The lights dimmed and the buzz in the auditorium began to subside. Carina clicked her remote and the screen turned on. Amelia let out a tiny gasp of surprise and her hand suddenly gripped Link’s leg.

“Hey, babe,” Link whispered. “What’s up?” He turned to find her staring frozen at the screen.

“Today I’m going to be talking about anencephaly in infants and how an earlier diagnosis of this birth defect can be achieved.” Carina stated proudly. Amelia couldn’t tear her eyes away from the screen. Every part of her wanted to cover her ears and block out what Carina was saying but she couldn’t. Instead she stayed frozen in her seat. She could feel Alex’s eyes on her. She knew if she turned to him he’d have that sick sympathetic look on his face that everyone she’d ever told about Christopher had given her. The auditorium was suddenly a hospital room and in her arms was a rounded, warm blanket. Little squeaks filled her ears, the same ones that had replayed in her mind a million times.

“Amelia?” Link’s hushed, worried voice brought her back to reality. He brushed his fingers over hers and she looked down to see her knuckles white, gripping into his thigh.

“I’m sorry, I…” she trailed off. Link could see panic in her eyes. Then something changed and she rocked forward slightly. “I’m going to throw up.” She pushed past Jo and Alex and quietly exited the auditorium. She barely made it to a waste bin before her entire breakfast spilled out. She felt Link’s hands pull back her hair as she spat the last couple of chunks into the bin, cringing at the acidic taste.

“Is she okay?” Jo’s voice entered the hallway.

“Jo,” Alex pulled back his girlfriend who’d followed the two surgeons out of the auditorium. “Don’t draw attention.”

“She’s sick, Alex.”

“She’ll be okay,” he winced as he took in Amelia’s panicked state. “Just give her space.” He tugged Jo back into the lecture room.

“Mia, talk to me,” Link pleaded before glancing at her abdomen. “Do you think you’re having morning sickness?” “I think I’m having a panic attack,” Amelia admitted through gasping, shaky breaths.

“Oh.” Link’s eyes flew open. “Come with me.” He guided her into and on call room before wrapping his arms around her and coaxing her into breathing regularly. “Feeling better?” “Mhmm,” Amelia replied shakily, trying not to spill the cup of water that Link had passed her. He helped her take two large gulps and then placed the cup on the ground.

“Lie down,” He ordered, wrapping her in the bed’s duvet. “You’re freezing.” Amelia nodded and curled up into the covers, relaxing into Link’s protective grasp. “Are you okay?” He finally allowed himself to show emotion and Amelia was surprised by the pain in his voice.

“Yeah.”

“You want to talk about it?”

“Not really,” she confessed. “Can you just lie with me for a bit?”

“Of course,” he sighed, placing a careful kiss on her forehead and wrapping his arms around his trembling wife. “I love you.” “I love you too.”

Amelia awoke to the light peeking through the blinds of the on call room. Link lay soundlessly beside her, his brow furrowed in concern even in his sleep. “Link.” She shook him awake. “Your surgery.” “It got pushed,” he groaned, rubbing the sleep out of his eyes. “Come here babe.” He opened his arms wide and allowed Amelia to cuddle up to him.

“I had a baby,” Amelia stated.

Link’s eyes opened in confusion. “Pardon?”

“When I lived in LA.”

“With Addison and Charlotte?”

“Yes.” She nodded. “My fiancé,” she started, ignoring Link’s uncomfort, “the one who died. It was his baby.” She wasn’t sure why she was telling him this. “Anyways, I didn’t want to get a scan cause I was high for the first month of my pregnancy. I thought there was no way that I could be carrying a healthy baby.” Her voice filled with pain as she continued. “And I was right because I found out five months in that my baby had no brain.”

“Anencephalic.”

“Yeah,” she swallowed back a sob. “And um, I was five months so I couldn’t really do anything about it at that point.”

“Oh Mia…”

“So I had the baby, Christopher, and he lived for forty three minutes and he was beautiful.” Tears were running down her face. “So I think that’s part of the reason why this IVF thing has been really hard. Cause I’m worried that even if I do get pregnant there’s going to be something wrong.”

“Amelia the chances of that happening again are so low.”

“But not zero,” She wiped her nose on her scrub top. “It’s just been a lot, Link.”

“If I’d known--”

“I didn’t want you to coddle me.” She turned to look at him. “And for you to give me the exact look you’re giving me right now. The look that everyone gives me when I tell them.”

Link looked away, “I’m sorry.” He brushed away a couple tears of his own, cursing under his breath that he should be stronger for her. “I don’t want you to feel like you can’t tell me things. I want to be there for you no matter what. Nothing you could tell me is going to make me think that you are any less strong or capable than I know you are.”

“I think I might be, Link.” She finally admits, feeling the weight she’d been carrying for the last couple of days lifting off her chest. “I haven’t taken a test but the last couple of days have felt different.” She couldn’t meet his gaze. “I’ve also been craving pepperoni which is the only thing I felt like eating when I was pregnant with Christopher.”

“Amelia.” Link was speechless.

“Link, if anything is wrong with our baby I won’t be able to forgive myself.”

“You won’t have to,” he puts simply. Suddenly he’s smiling and tears are falling down his cheeks. “We’re going to have a baby?”

“Possibly,” she nods, laughing as he throws his arms around her. “Careful.”

“Sorry, sorry!” He exclaims before pressing a feather light hand to Amelia’s stomach in awe.

“Link, baby steps.” Amelia winces.

“You’re kidding,” Link groans, before meeting Amelia’s worried blue eyes. “This is good?” He confirms.

“We need to get past the first trimester and then we can call it good,” she replies lightheartedly.

“You’re gonna have a baby bump,” he practically sings. “You’re gonna have my baby in your belly.”

“About that.” She bites her lip. Link looks up at her with shock. “I’m kidding!” She laughs.

“I hope he has my humour,” Link growls, mocking a hurt expression.

“He?” Amelia questioned.

Link nodded, “We’ve already agreed.” “We?”

“Me and baby,” Link explains.

“I still need to take a test.” Amelia shakes her head in amusement. Link was already running out the door. The test, taken in the attending lounge’s washroom, confirmed Amelia’s suspicion. Suddenly they were both crying and Link was wrapping his arms around her, taking extra special precaution around her midsection.

“I love you so much,” he kept whispering into her hair.

“I love you too,” Amelia whispered, still trying to wrap her head around the fact that a baby was growing inside of her for the second time.

[oboevallis]

will he be okay?

TW: Chrons disease

ive mentioned in a story before about how bennys character is based off my friend and i, so i asked him if it was okay if i added this into this story and he agreed, he was diagnosed with Chrons disease when we were in third grade, and he’s been such an optimist through out all the struggles he’s faced throughout the years and ive never had such respect for someone or have met anyone stronger, i hope everyone is doing well and staying safe

"I'm going to go get the kids from he school bus, and make sure they don't bring home any more stray dogs." Link said as he stuck his head through the door to the nursery.

"Alright, just make sure they're quiet when they come in. I'm hoping this guy will go right to sleep once he's done eating."

"I'll make sure of it." He assured as he quietly shut the door. Before he left he secured the dog on his leash and made his way to the bus stop.

Once his kids got off the bus they ran to him, or so he thought. The pair leaned down to pet the dog, unintentionally ignoring their father.

"Hello to you too." Link did his signature wave trying to catch his kids attention.

"Sorry Dad." Scout apologized as he jumped up to hug his father. "I just missed Rex, and it seems like he missed us."

"He did, he stayed by the window all day waiting for you two."

"Aww, that's kind of sad." Scout replied taking the leash from his dad, trying to show that he could handle the responsibility of a dog.

"Well he's happy now." Link ruffled his son hair in attempt to comfort him, he looked back to see his daughter trudging behind. He walked over to her and picked her up. "Everything okay? You seem kind of down."

"Yeah." The girl sighed leaning her head on his shoulder.

The father looked at her daughter, concerned. For the past couple of days she seemed to be down, he was starting to worry that she was feeling left out. He didn't want her feeling like the cliche middle child, he wanted her to feel loved and attended to. Before he opened the door he reminded them to be quiet to allow their brother to sleep.

"How was school?" Amelia whispered as she walked down the stairs to be met with her family.

"Good!" Scout whispered, as he unbuckled the dogs leash. "I got 100 on my spelling test!"

"Good job!" Amelia congratulated. "And how was your day Addie?"

"Fine." She sighed walking away as her father let her down.

"Is she okay?" Amelia asked her husband as the girl was put of ear shot.

"I don't know, she's been quiet since she got off the bus. Is she feeling left out do you think?"

"Maybe? I mean we've been pretty preoccupied with the baby. I'm gonna talk to her tonight."

_______________________________________

"So which story are we reading tonight?" Amelia asked her daughter as she sat on her knees by the bookshelf.

"Can I just go to sleep?" She asked turning around to face the wall.

"I'm sorry me and your dad have been so preoccupied with Anders, it doesn't mean we love you any less. We still love you so so so much." The mother was met with silence, She stood up to sit on the edge of her daughters bed placing a comfortable hand on her leg. "Alright you don't have to talk, but you still have to wake up early tomorrow for book club even if it's Saturday."

"I'm not going to book club." This statement shocked the girls mother, there was never a week she missed it if she could help it.

"Why?"

"I just don't want to."

"Did you and Benny get into a fight?" To this her daughter started to cry. Amelia moved herself so she could embrace her daughter. "What happened?"

"He hasn't been in school for almost two weeks. And I don't know if he was at book club last week because we went to see Anders." The girl cried into her mother's chest.

"He could have the flu. We'll see if he's at book club tomorrow and if not I'll cal his dad."

"No, I don't want to go without Benny."

"Okay." Amelia kissed the top of her daughters head and allowed her to cry.

_______________________________________

"What'd his dad say?" Link asked when his wife walked back into their sons nursery.

"They're still running tests, but they think he has Chrons disease."

"God, poor guy." Link sighed, as he rocked his son to sleep. He knew what it was like to grow up in a hospital, and it sadden him that such a good kid like Benny had to go through that. "Are you gonna tell Addie?"

"No, not until they confirm the diagnosis." Amelia kneeled down at the rocking chair where her husband and son resided, and rubbed her sons head. "With Christopher I didn't really have to watch him suffer that much, I-I just can't imagine watching your kid be in so much pain everyday and your powerless to fix them."

"Me either."

A knock on the door, taking them out of their conversation. Their daughter slowly opened the door, and smiled at her parents.

"What did his dad say?" She asked as she walked over to admire the baby with her parents.

"Well, um he's sick so he's at the doctors right now. Their gonna run tests to see what's going on."

"And their gonna fix him?" She asked hopefully, a smile plastered across her face. The couple looked at each other unsure of what to say to their daughter.

"Their gonna help him feel better." At the moment there was no cure for the condition, but there was treatment to help manage the pain and to keep it from progressing.

"That's good, I can't wait till he's back at school." Addison stated before she left the room.

"Did we just give her false hope?" Amelia asked biting at her nail.

"No, no, kids are resilient, and they can live pretty normal lives with the condition. I mean he probably won't be at school too often, but I saw kids with the disease while at the hospital and their still normal kids with normal lives." Link assured.

_______________________________________

It had been three weeks since Bennys diagnosis of Chrons disease had been confirmed. His dad called Amelia, asking if Addie could come by and say hi. Benny was pretty upset, and wanted to see his best friend.

"Hey Addie." Amelia leaned in her daughters doorway.

"Hey mommy." She laid in the middle of the floor, watching her fan spin around. Her mother moved to lay next to her.

"Do you remember when we talked about Benny being at the doctors?" The girl nodded in response. "Well he has something called Chrons disease. So his intestines are inflamed, which causes him to have a lot of stomach pain." She tried to state it in the simplest of terms and the less scary version.

"Okay, when do they do surgery to fix it?" The five year old asked.

"Well surgery isn't going to fix this, he may need it in the future to help him, but this doesn't get cured. The doctors are looking for a cure, but they've figured out how to help people manage it and not feel as bad."

"Oh." Amelia could see the sadness on her daughters face. "He'll still go to school right?"

"Well he'll try, but probably not a lot."

"How will he learn?"

"The teachers will probably send work home to him, and a tutor will come by and help him."

"Will he still be able to play?"

"When he feels up to it."

"What about reading?"

"He'll still be able to read."

"Can I see him?"

"Yeah, actually he asked if you can come over tomorrow." The girl nodded vigorously in agreement, she could tell the girl was trying to be strong. The little girl wrapped her arms around her mother, allowing tears to stain her shirt.

________________________________________

"Hi." Addie shyly greeted as she stood at his bedroom door.

"Hi! Come in!" He cheerfully said, waving at her to walk in further. "Let's color, I printed out some new coloring sheets.

"Okay." She agreed sitting next to him on the floor and picking up a crayon along with a sheet of paper. "Do you feel okay?"

"They gave me some medicine, it helps a little bit."

"Does that hurt?" Addie asked pointing to the IV in his arm.

"No, and can we not talk about my sickness and just color?"

"Yeah." Addie smiled brightly, she wanted to help her friend but she was relieved that they could pretend everything was normal.

"Did your mom have the baby?"

"Yeah, his name is Anders. Oh! And we got a dog!"

"Really?! What kind of dog?" He matched her excitement, he knew how much she wanted one.

"We're not sure we found him hurt in a park. His name is Rex though."

"Next time we go to he park you need to bring Rex and I'll bring Buddy. They're gonna be best friends just like us!"

"Best friends." Addie smiled looking at her friend before she continued to color.

[drferox]

20 Questions with Dr Ferox #20

Sometimes it blows my mind how many questions and comments you all have and want to share. This makes 400 we’ve got to in this format. Once again I’ve tried to tag people, but if you sent a question on Anon you’ll have to look yourself to see if you were answered.

@crazy-aquarium-lady said: Do you have any experience with farm or large animals in general? Goats for instance?

I spent the first few years of my veterinary career working in mixed practice, which included large animals and goats. I really did enjoy goats, though they often weren't kept as seriously as other livestock, but I'd have to admit I'm somewhat out of practice with large animals.

Anonymous said: omg all of your animal names are incredible. i once met two cocker spaniels called Beans and Trousers and that was pretty amazing

Bean and Trousers are great names too

@sketchingblanks said: Hi there Dr. Fox! Thank you for your wonderful blog and all that you do. My dwarf hamster recently passed away at the age of 3 and I'm a wildlife rehabilitator who has dealt with animal death many times before, but it's never quite the same when it's one of your own. However it did make me wonder what is the smallest animal you have ever worked with? Was it more fun or challenging? Question tax: How do you take your tea? I usually have something herbal (like peppermint/spearmint) with honey.

The smallest patient I've personally dealt with was a mouse. But the finch with the broken leg was pretty close. Believe it or not I don’t actually drink tea.

Anonymous said: Question: have you ever treated an arthropod (specifically tarantulas, because they can rupture their abdomen pretty easily) or know someone who specializes in that? Because I'm quite interested in knowing if vets provide care to arthropods, or if its better for the owner to perform medical care to their tarantula at home (ICU's, helping a bad molt, treating hemolymph leaks, etc).

I haven't personally treated an arthropod, though I learned a bit about them during work experience at the Melbourne Aquarium, most of their medicine seemed to be 'just don't make them sick'. There are vets that will treat them though, the Bird & Exotic Animal Clinic is my go-to for exotics (you should check out their facebook page).

Anonymous said: You dont have to reply to this if you dont want to, i just wanted to say i have rats and i love them so much and i will do anything they need at the vets. Because idk i thought maybe you might need encouragement that there are people who prioritize exotic animals health. I hear a lot of stories of people that wont get vet care for their rats but not a lot about people who do. Thought it might give you a little bright light amongst all the dark. Have a great day youre amazing.

People like you are definitely out there. Thank you for your comment.

Anonymous said: just needed to blow off a bit of steam because this still annoys me, but my father told me that taking a hamster to the vet to make sure she's healthy before taking her to college with me as a support pet was "a waste of money." granted, he hasn't taken the family cat to the vet in about seven years, so he generally seems to think that veterinary care is a waste of money. i love my hammy and i just want to make sure she's healthy, but since she isn't a cat or dog, she's "not worth it"

Anon, sounds like your father would think any dollar spent at a vet clinic is a waste of money, regardless of what sort of animal it was. There's not much you can do to change people's minds about this, so just do what you need to do.

Anonymous said: It's amazing how many people don't understand how economics works. They seem to expect vets to do everything for free or for cheap, but if they did that, how could they afford to eat? And besides that, you guys DESERVE to be paid for your time and effort. I wish more people thought about it like that instead of just looking at their bill and thinking that their pet's life isn't worth that much. Thank you for everything you do.

Veterinary medicine is one of the fields where people seem to think it's criminal for a practice to make a profit. Most other professions are not vilified for making a wage, but we're expected to like our jobs enough to work for free. Partly this is our own fault because we start to believe it after a while but we do frequently undercharge, do desexing surgery at cost, and treat strays and wildlife for free. The difficulty is most of this charity is invisible

Anonymous said: I want to say thank you as well because I thought I wanted to become a vet for the longest time, but reading this blog among others has actually taught me that it probably wouldn't be right for me. Now I'm more interested in something like a research professor. The amount of respect I have for you is boundless. I love seeing your work and following you and I think it's a good thing that I stumbled across this blog. This way I won't be stuck in a career that I wouldn't like.

Being stuck doing something you don't really like isn't a fun place to be. I'm glad you've found some more options and hope everything works out great for you.

Anonymous said: My favourite part of your blog has always been your vet stories, so I've been curious -- What kind of case/problem gives you the most satisfaction to solve?

Anything where I actually find a treatable diagnosis. Animals that get better 'mysteriously' are great and all, but I want to know why. And getting the answer is only bitter sweet if the answer is catastrophic or terminal. EPI, Addison’s and reconstructive cases are my favourite, because you can do so much good for them.

@daedricprincessxoxo said: Cute story for happiness: So a nurse-for-people brought in her dog for a sick visit. Unlike most human med people I've met, she was so respectful of those of us in veterinary medicine, and absolutely fascinated by how similar it all was to human medicine. Not only was she a dream client, her dog had freckles on its nose, which the vet adored too. What was funny is when she referred to the dog's spay as a hysterectomy instead.

It's great when you get a good one instead of a know-it-all. Technically a dog spay is an ovariohysterectomy though, we take those pesky ovaries out too.

Anonymous said: Im a vet assistant at a local shelter, and while helping a family look at dogs they remarked to me, "yeah our daughter is allergic to dog FUR but not dog HAIR. Do you know which dogs have just hair?" Needless to say, i was a little speechless and just recommended a poodle. Theres no real difference....right?

It's only semantics but some people like to use it to feel special. Hair and fur are chemically the same, if you're really allergic to one you're allergic to both, but hair is finer and typically longer so either doesn't shed or sheds much more rarely. It's weirdly common for poodle owner to be proud that their dogs have hair instead of fur. As long as they end up loving the dog, it doesn't really matter.

Anonymous said: Here's one: I work at a pet store. A man came in asking for a remote electric shock collar for a 3 lb Yorkie. Told him we carried nothing small enough to be safe. He told me it wasn't for barking - he and his wife had cattle, and when they went to visit the herd the dog would go pelting towards the cows. He said, "I just need something to drop er so she don't get stomped." I suggested a leash. He replied, "Nah, she don't like leashes."

Nothing the general public does or says surprises me anymore.

Anonymous said: I have a natural English Cocker. Her tail is heavy, constantly wagging, and a hazard to any legs in the vicinity :) Where I am there's a lot of working cockers, and hunters will swear up and down that docking is necessary because they'll ruin their tails in the brambles, etc. I'm not convinced - my (pet) dog loves diving into thick cover and this has never been an issue. Their ears are surely more of a risk, I'd think, but no-one's trying to crop those. Is there any real merit to docking?

No, there is no real merit to docking healthy tails and you're correct in assuming the ears of cocker spaniels are far more problematic for these dogs. Cocker Spaniels are the most notorious breed for difficult, drug resistant ear infections, with quite a few of them requiring lateral or total ear canal ablation surgery, but nobody would even think about docking Cocker Spaniel ears. This is because docking and cropping are done for aesthetics, not function.

@cakeandpi said: A long time ago, I took my cat in to the vet because he was limping badly and did not want to be handled. Turns out, rather than breaking his leg or anything like that, his hip joint had essentially eroded away and - to quote - “looked like swiss cheese”. His leg was amputated and it healed nicely, though he never let anyone close to that part of his body again. He had a long, easy, and mobile life, until he was roughly 18 years old (he was a shelter rescue) when his kidneys finally gave out on him for good. Whatever happened to his hip bone, it was unusual enough that the vet sent a sample to a vet research clinic. It’s been a few years since my cat passed, and even more since his amputation, but it helps a little to think that that sample might one day help, I don’t know, with orthopedic research or something of the sort. Maybe. Question tax: I really like your fantasy-animal science posts!

I of course have no way of knowing where the hip bone went, but I'm sure somebody, somewhere will make use of it. Veterinary Medicine is advancing all the time, which is the best thing about science, and accumulating raw materials and data is critical for us to be able to do so.

Anonymous said: hi dr ferox! i love your blog! earlier today my sister cut our cat's claws with human nail trimmers. i know you're not supposed to do that, but i don't know why. i looked at his claws after she told me she did it and they don't look hurt. should i be worried? thank you so much!

I use human nail trimmers on my cats' nails all the time. It's fine if your technique is good, though they're not the easiest device to use for that purpose.

@gemma-handyman said: Dear Dr Ferox, I've tried to find the answer via google but have come up short. Do you know why some cats have such an affinity for loaves of bread? For instance, my grandmother's cat, Cece, would drag loaves beneath my grandmother's bed and fiercely protect the pilfered loaf. She's not the only cat I've heard of with a strange penchant for gluten and carbohydrates. Do you know why some cats love loaves of bread? Question tax: came for the mythical breed breakdowns- stayed for the irl info

Cats can digest carbohydrates, and from a metabolic point of view they're likely treating it as glycogen in terms of dehydration. Some cats like novel chewing textures, celery leaves is another common thing for cats to like, so may be just chewing it for fun.

Anonymous said: I want to be a vet tech but everyone always says I'm selling myself short... vet techs are just as useful right?

Of course they are. Have you ever seen a human hospital function without nurses?

Anonymous said: So our clinic has a batch of neonate puppies. 10 of them. I'm clearly not going to be able to sleep for the foreseeable future, as I'm on puppy duty. At least they're cute.

Good luck bottle feeding the little squeakers. They'll turn into waddling balls of chaos soon enough.

@fndm-trsh-sht said: my cat is a lil shit- but a cute lil shit- t h a t i s a l l- *slinks awaayyy*

Most cats are buddy, but we love them anyway.

Anonymous said: Something about the angle of trashbags ears reminds me of a goblin. Hes wonderful

He is a bit of a gremlin, he's starting to grow into his ears though.

[matthillica]

Pandemic - Day 7 (Weds 3/18/20)

Not even sure where to begin this, suffice to say I've had a nagging feeling over the last few days that I need to document this as we all hurtle toward the unknown.

I haven't touched this blog in almost exactly 10 years, which is crazy to think about. Crazy that something I used to spend so much time agonizing over and pouring thought into has become antiquated and obsolete... only to become the one outlet that makes sense during this crazy time.

Yesterday I set up the Kinect on my Xbox, another obsolete piece of technology. Because I'm a nerd and always have to have the newest, hottest, flamingest shit, I got one of the first Xbox Ones to come out, which came with the second generation of Kinect sensor... you know, the one Microsoft tried to shove down all our throats relentlessly. Anyway, we basically used it as a voice operated remote to browse Netflix. "Xbox, pause" "Xbox, play" "Xbox, rewind"... you know, shit Americans are known for. Anyway, Microsoft eventually gave up the ghost and phased the Kinect out. Mine's been sitting on a shelf gathering dust for at least 2 years.

Now, it's a way (if I can get the damn thing working again) for us to use an outdated Skype app so that we can talk to Grandma on a daily basis. My daughter, Caroline is almost 2 (yes! I have a daughter now and have been married to my wife since September 2015). Grandma is in Kansas, set to move to be with us in Atlanta as soon as her house sells. She was supposed to come visit us 3/27, but it's looking like that won't happen now. I told her if she was able to get in the car TODAY and make the 14 hour drive, stopping only for gas and to sleep in her car, that she's welcome to come stay with us and ride this thing out. Tearfully, she told me she needed to stay in case someone wants to come look at the house.

Honestly, it's going to be safer for her there anyway. McPherson has around 15,000 people. Meanwhile Atlanta is set to blow with this virus and cases have started to double overnight. It's hard to know how many there really are simply because there's a shortage of testing. Personally, I think by this weekend, our healthcare system is going to be in the grips of the worst crisis it's ever seen.

I should also mention that my wife has some autoimmune health issues that are pretty unique. She suffers from Schmidt's Syndrome which is a combination of Addison's Disease and Hypothyroidism. It's something that can be managed with a daily regimen of drugs, but is a serious condition that can be exacerbated by illness. The story of her diagnosis and the things we went through to get to it could fill a book at this point. I have taken more trips to the ER in the last 5 years than I care to mention and many of them have been triggered by illness, whether that's a common flu or something given to my wife by Caroline from her daycare or mastitis... even the slightest thing can send her into adrenal crisis, which immediately requires a trip to the ER.

So... as you can probably guess... I'm pretty fuckin nervous about all this. Luckily, I have been quietly prepping and watching this story develop, so we have plenty of food, water, and meds to get us through the next 60-90 days. My concern is that if my wife catches this, which she probably will, we may need a trip to the ER... and that's the last place on earth I want to be right now or for the forseeable future.

I should ALSO also mention... my wife is 13 weeks pregnant with our second child. This means that now, not only do we get to navigate our way through a pandemic AND Schmidt's... but we also have to deal with morning sickness and fatigue, all the while playing the game of "Is this symptom just pregnancy OR is it your Schmidt's OR is it Covid?"

Anyway, the last few days have been rough and we're only at the beginning of this thing. My wife can barely stand due to fatigue. She basically moves from one flat position to the next... shuffling quickly from our bed to a sofa or from the sofa to the kitchen and back as quickly as she can. It's slightly horrifying. I've been trying to cram fluids and food down as much as possible, but it's hard when someone doesn't feel well. I got her a bottle that lights up every 30 min to remind her to drink, but that's not really helped much at all. I grabbed protein shakes from the store in an effort to find something high calorie with vitamins, etc. that she can drink easily. I basically had to hold a gun to her head to make her drink it this morning. I'm equal parts husband and taskmaster. It sucks.

Last night she said she felt the fatigue was getting worse and that it wasn't due to pregnancy. I can connect with her doctors via an app that allows me to send them messages... Laura was too tired last night to do this herself, so I fired off an email to both her endocrinologist and OBGYN. No response.

In preparation for a doctor visit today, which we assumed we'd be able to schedule, we drove to Laura's folks' house so they can watch Caroline while we go to the doc. We tried calling the docs on the way over, but it seems they're already trying to stem the flow of patients. It's worrisome when you're living with someone who has a life-threatening illness to see the system strained already when the worse is yet to come.

Anyway, not long after we got to my in-laws' house, Dr. Patel (endocrinologist) called me directly. After discussing Laura's symptoms with him for about 10 minutes, he said we need to go to the ER so that she can be given fluids via IV. I said, yeah... no I don't want to go there AT ALL. But he said really, we need to go as this is the only way to deliver IV fluids. I thanked him for calling us and he said he'd call back tomorrow to check in.

So... what to do? Do we drive into what we KNOW is a situation that will expose us both to Covid so that she can be given IV fluids and told she needs to eat more, which I can almost guarantee you is what will happen since we've been through this a dozen times before? OR do we do what we can at home, try to see if we can force fluids and food to make her feel better, then reevaluate tomorrow when, in all likelihood, the situation will be even worse at the ERs? Neither is a fantastic choice.

For now, we've decided to stick it out here at her parents and see if we can force the fluids and food for today. At the very least, tomorrow when we wake up if she is still not feeling better, we'll be able to say that we know she's not dehydrated and we know she's had enough food. I know it will be worse at the ER tomorrow, but if going there is a Covid sentence either way, seems like it would be smarter to delay that option as long as possible.

So that's the situation right now. We're all "working from home" at this point. I have a desk set up at home and have grabbed my monitors, so with the exception of the folding table set up in Caroline's playroom, it's just like my normal office setting, basically. It's interesting attending meetings and trying to handle the business-as-usual functions of our jobs while the world around us starts to crack and crumble. I can't help but wonder how long this routine will go on before each one of us is just in 100% survival mode, unable to track or even care about projects that have lost their meaning in the context of this incredible, unbelievable, worldwide crisis.

It's crazy to think that everyone... EVERYONE on EARTH... is living out their own versions of this story, complete with difficult situations to navigate and impossible choices to make. My own drama is consuming all of my mental real estate right now, so my heart is with everyone who is dealing with their own all-consuming drama as well.

Be good to each other over the coming days and weeks. Stay strong and as positive as possible. Take care and stay safe.

-Matt

[ouraidengray4]

Is It Adrenal Fatigue or Are You Really Tired?

Do you ever have that super-fun combination of high-level stress and absolutely no energy? Though you might be feeling stressed and tired from the litany of horrors in the news or just a super-obnoxious Facebook feed, there could also be an adrenal imbalance exacerbating your symptoms. That said, your adrenals might not have anything to do with it. Adrenal fatigue has become a hot diagnosis from naturopaths and alternative medicine practitioners, but the traditional medical community is not jumping on the fatigue bandwagon.

Before you start to worry about your hormonal balance, here's everything you need to know about adrenal fatigue, the controversy around the disease, and what to do if you're experiencing symptoms.

What Are the Adrenals?

The adrenal glands are responsible for regulating a number of hormones that affect your metabolism, blood pressure, and immune system response. But the real star of the adrenal show is stress.

Both cortisol and adrenaline are regulated by the adrenal glands. Adrenaline (and its close cousin noradrenaline) gets involved during high-stress times when your body sets off the "fight-or-flight response." You know, that feeling when you see an absolutely horrible tweet and you're not sure if you should spend your day dismantling the troll or go hide under a blanket for a few hours.

For lower-level stress, cortisol takes control. The hormone is raised in stressful situations and causes your heart rate to increase, helps you metabolize sugar more quickly, and generally gets things moving to respond to non-relaxing situations.

EDITOR'S PICK

What Is Adrenal Fatigue?

In 1998, James Wilson, DC, Ph.D., coined the term "adrenal fatigue," which is also called adrenal stress, adrenal exhaustion, hypoadrenalism, or "that thing where you're tired all the time and I think it's stress or something" if you're talking to your mom's friend who saw something about adrenal fatigue in a magazine in the checkout line at Whole Foods.

Adrenal fatigue doesn't mean you have sleepy little glands sitting on top of your kidneys. Some doctors believe it is caused by overworking the adrenal glands. When your body is exposed to long-term stress and your adrenals keep pumping out hormones to cope, eventually they get tired out. The adrenals can't produce enough of the necessary hormones to handle the chronic stress.

Once the glands are fatigued, Wilson says you can experience an array of symptoms, like:

Tiredness

Weight gain/inability to lose weight

Brain fog

Feeling run down or overwhelmed

Craving salty or sweet snacks

Trouble bouncing back from stress

Adrenal fatigue is different from Addison's disease or adrenal insufficiency. For those disorders, the adrenal gland is physically damaged (often from auto-immune issues) and cannot produce the proper hormones. For adrenal fatigue, the adrenals are physically intact, they just aren't working properly.

Basically, it's a medical condition caused by too much stress, and Wilson claims this disease is brought on by all the added stress of the modern world. Though we may have fewer true "fight-or-flight" moments than our ancestors did, we are barraged by low-level stressors at almost all hours of the day. Sure, early humans had to build their own homes out of hard-to-work materials and ward off bear attacks, but they weren't checking their phones at 1 a.m. to make sure their boss wasn't mad at them.

But Is Adrenal Fatigue Real?

In "Adrenal Fatigue Does Not Exist: A Systematic Review," scientists at the Federal University of Sao Paulo say that adrenal fatigue is definitely real. Just kidding! The title pretty much gives it away. When these professionals searched through 3,470 studies on PubMed about adrenal fatigue, they found no substantial proof that it's a real disease. Previous studies that supported adrenal fatigue didn't properly measure the patient's stress hormones, and there were few scientifically sound studies of the disease to begin with.

The Endocrine News stated that most of the symptoms of adrenal fatigue don't match symptoms of adrenal insufficiency, the scientifically proven disease. With insufficiency, you'll see weight loss, vomiting, diarrhea, nausea, fatigue, and low blood pressure. With fatigue, people complain of feeling tired, not wanting to get out of bed, craving junk food, and weight gain. Though both disorders make you tired, it doesn't make sense that adrenal insufficiency (caused by physically damaged glands) would produce such different symptoms from an adrenal gland that's just too tuckered out to make enough hormones.

To add fuel to the "adrenal fatigue is a myth" fire, the Endocrine Society does not recognize it as a real disorder, and Google is littered with articles like "Adrenal Fatigue: A Fake Disease" from qualified medical professionals. In short, the medical community thinks adrenal fatigue is completely made up.

If Adrenal Fatigue Is Fake, Why Am I Hearing About It So Much?

When Wilson coined the term "adrenal fatigue," he gave a name to a host of symptoms that plagued many patients. Even today, he still uses this questionnaire as a primary diagnostic tool. Here's some sample questions where you rate each answer on a scale from 0 (never) to 3 (intense or frequent):

My ability to handle stress or pressure has decreased.

My thinking is confused or hurried under pressure.

My muscles sometimes feel weaker than they should.

I often become hungry, confused, shaky, or somewhat paralyzed under stress.

I have difficulty getting up in the morning.

I need coffee or another stimulant to get me up in the morning.

How did you do on the quiz? You probably got quite a few 2s and 3s, right? Of course! Every time I look at the quiz, I think, Oh crap, I probably have this because it presents a lot of symptoms that are incredibly common. To be fair, the full quiz is much longer than this and some of the questions are fairly specific ("I get pain in the muscles on the side of my neck" and "My best, most refreshing sleep comes at 7-9 a.m."). But most of the question are vague and apply to a wide swath of people.

Wilson published his theory of adrenal fatigue with a version of this quiz in his book, Adrenal Fatigue: The 21st Century Stress Syndrome. That book was recognized by a few medical societies, though none of them were supported by any official American board of medicine, according to Cedar-Sinai.

Since the symptoms are so common and adrenal fatigue seemed to finally give people an answer to the "Why am I tired all the time, can't lose weight, and feel foggy" question, a lot of people supported (and still support) this diagnosis. "Adrenal fatigue can have debilitating symptoms on the body," says Suzanne Demers, DC, and doctor of functional medicine. "Many people will gain weight and will not be able to get the weight off, and may also feel mild depression or a decrease in their ability to handle stress."

Demers isn't alone, as many naturopaths and doctors of alternative medicine believe in adrenal fatigue. Most will claim that conventional medicine hasn't caught up with their knowledge of the disease (like Dr. Wilson does on his site).

Though the evidence doesn't support adrenal fatigue, it doesn't 100 percent prove that it doesn't exist. In 1981, Barry Marshall, M.D., discovered that most ulcers were caused by a specific bacteria, but the medical community balked at his hypothesis. His ideas didn't start gaining traction until he drank the bacteria, gave himself an ulcer, and solved the whole thing with simple antibiotics. In 2005, he was awarded a Nobel Prize for his scientific breakthrough.

Now, this one story doesn't prove that scientists are always wrong. It simply shows that discoveries can happen that the medical community doesn't automatically agree with. In the case of adrenal fatigue, it's very unlikely that the medical community is incorrect. But naturopaths and people seeking alternative treatments have enough doubt to keep their faith in fatigue.

EDITOR'S PICK

But I Have Adrenal Fatigue Symptoms—What Can I Do?

Here's the thing. Even if adrenal fatigue isn't real, your symptoms are. Feeling tired all the time, moody, cranky, crave-y, stressed, and depressed are all real things, and you shouldn't have to feel that way. With these persistent symptoms, it's best to tell your doctor to try to get a more specific diagnosis. If you've already seen the doctor, or your symptoms are mild and you want to figure it out on your own, there are a few major potential culprits for your adrenal fatigue symptoms.

If It's Not Adrenal Fatigue, What Is It?

Though studies show that stress doesn't wear out your adrenal gland, that doesn't mean that stress doesn't have consequences on your body. A paper from the University of Miami found that chronic stress directly led to high blood pressure and decreased immune response. When stress hormones stayed high, patients recovered more slowly from disease and got sick more easily. The paper also found that symptoms usually associated with getting sick (fatigue, malaise, no appetite) weren't caused by the illness but by the body's attempt to get better. Basically, the stress of fighting a cold is what causes all the crappy feelings, not the actual cold itself.

A study from University College London found a positive link between chronically high cortisol and obesity. This doesn't prove that stress causes weight gain but shows that high-stress hormones may be part of the cause. Even if high cortisol isn't the main cause, stress has a clear impact on weight since most people turn to food or alcohol when they're stress levels get out of hand. If you constantly feel stressed and repeatedly turn to ice cream and nachos to calm you down, weight gain is fairly likely. At the very least, that's exactly what I did a time of great stress, and boy, howdy, did I gain weight! Obviously, not everyone responds to stress with eating, but it certainly happens.

So, stress can cause fatigue, malaise, no appetite, more appetite, high blood pressure, decreased immune response, and weight gain—almost all the symptoms of adrenal fatigue.

If you really don't think stress is the problem, it might be depression. Now, depression sounds very scary and bad, but it's common and treatable. About 16 million Americans have major depressive disorder, while 6.8 million adults have generalized anxiety disorder, according to the Anxiety and Depression Association of America (ADAA).

Before you think, no way, I'm definitely not depressed, here are some of the major symptoms (via the ADAA):

Persistent sad, anxious, or empty mood

Decreased energy or increased fatigue

Insomnia, waking at odd hours, or oversleeping

Weight gain

Weight loss

Restlessness

Headaches, digestive disorders, and pain that doesn't seem to have any other cause and doesn't respond to treatment

Sounds a lot like the adrenal fatigue symptoms, huh? Depression isn't just feeling sad, it can also manifest in complex physical and emotional ways. Using myself as an example, I had horrible pains in my stomach that no one could figure out (even after $4,000 worth of testing. Thanks, crappy insurance!) But when I finally got help for my full-out major depressive disorder, those pains went away.

Now, hearing "it's just stress or maybe depression" might not be very comforting. But there's a lot you can do to fight the symptoms of general stress, even without seeing a doctor. However, if you think it might be depression, it's definitely worth seeing a mental health professional for a full diagnosis and options for treatment.

Alternatively, you may have hypothalamic-pituitary axis dysfunction (try saying that five times fast). Either way, you should get checked out—if you've been experiencing a lot of the symptoms associated with adrenal fatigue, your doctor is almost certainly going to want you to get a full workup for fatigue in general.

How to Feel Better

Many of the suggestions of how to combat adrenal fatigue are also helpful for stress or mild mood disorders. They aren't always easy, but the suggested dietary and lifestyle changes could ease your symptoms.

Sleep

The most important thing to do for your symptoms is to reduce stress, and one good way to do that is to get more sleep. Have you ever started crying over something because you were just too tired to deal? I have! By simply getting enough sleep, you can immediately relieve some of the symptoms associated with adrenal fatigue.

"Stay on a regular sleep schedule of 8-10 hours per night," Demers says. This will increase mental clarity, improve your mood, and make it easier to deal with stressful situations. Getting 8-10 (10!) a night is easier said than done, especially if you have kids. Demers recommends going to bed at the same time every night and getting in some activity (even walking) during the day. The combo of routine and moving your body will help you relax at night and get to Snooze Town a little faster.

Change Your Diet

Since inflammation is one of the main causes of internal stress, it's best to cut out inflammatory foods and add in healthy fats and natural anti-inflammatory ingredients.

Foods you should eat more of tend to contain high levels of omega-3 fatty acids, which help reduce inflammation. Omega-3s are vital to fighting the symptoms of adrenal fatigue, according to Barry Sears, Ph.D., founder of the Inflammation Research Foundation and author of The Zone Diet. He recommends taking fish oil supplements to get a high, concentrated dose of omega-3s. "When you increase the intake of omega-3 fatty acids, you reduce the production of pro-inflammatory hormones (eicosanoids)," Sears says. This helps counteract the effects of chronic stress on the body. As inflammation recedes, people usually feel more energetic and experience weight loss.

This dietary approach does not work overnight, but you should see some change in symptoms after 4-6 weeks. If, after a few months, this dietary change does nothing but make you angry about all the coffee you can't drink, it might be time to see a doctor and reevaluate your symptoms.

Just Straight Up Lower Your Stress

The top way to fight the symptoms of adrenal fatigue is to lower your stress. Easy, right? Nothing's more soothing than someone telling you, "Relax! Relax right now, or your health will suffer forever!"

You can't expect stress to disappear immediately, but you can find ways to relax. First, to continue to overcome your stressors, you have to identify them. Take a few minutes to list out everything that causes you stress. It doesn't matter if it's a huge thing like debt or something small like a cubicle mate who plays games on their phone with the volume turned up—write it down. Then, see if there are any stressors you can get rid of. Sure, you can't magically erase major stressors, but taking away some of the small things can make a big difference.

"Most importantly, schedule time for yourself each week or every other week," Demers says. Take at least two hours a week to spend totally alone, doing whatever you want. No thinking about work or planning your trip to the grocery store. Instead, use those two hours to quietly read, get a massage, or go sit in the park. Honestly, you could stare at a wall or binge Real Housewives—just do anything that feels soothing to you. And no matter how busy you are, put this "me time" in the calendar and stick to it.

I Still Think It Might Be an Adrenal Problem

If you're concerned that you may have Addison's disease or adrenal insufficiency, it's best to get ACTH stimulation blood tests. You give a little blood, then get a shot of adrenocorticotropic hormone (ACTH), and give blood again. Essentially, this shows how your body reacts to the cue to give cortisol. This test won't confirm adrenal fatigue but will help diagnose even more serious adrenal disorders.

If you or a doctor still believe it might be adrenal fatigue, you can ask for a saliva test. The cortisol/DHEAS saliva test measures the stress hormones in your spit and how they change throughout the day. If your results show low adrenal function, you can talk to your doctor (or make some of the dietary and lifestyle changes suggested in this very article). Now, this test is not recognized as a proper test for cortisol levels and was shown to be faulty in 61 percent of patients, according to the Harvard Health Blog. But if you're curious about your hormone levels throughout the day, this test could give you some insight into what's going on in your body.

Adrenal fatigue may or may not be real, but that doesn't mean your symptoms are "made up" or "all in your head." More likely, general stress is the cause, and it's screwing with your body in a variety of ways. If your symptoms are severe, please see a doctor and a mental health professional; and in the meantime, you can take note of your symptoms or try some of the dietary changes and see if they make a difference. But most of all, try to reduce your stress. No matter the official diagnosis, added relaxation is medicine we all should be taking.

Amber Petty is an L.A.-based writer and a regular contributor to Greatist. Follow along as she shares her weight-loss journey in her new bi-monthly column, Slim Chance. Take singing lessons from her via Sing a Different Tune and follow her on Instagram @ambernpetty.

from Greatist RSS http://bit.ly/2TYGlRl Is It Adrenal Fatigue or Are You Really Tired? Greatist RSS from HEALTH BUZZ http://bit.ly/2U34XIV

[cannamama843-blog]

Living with an invisible illness

I got really sick back in July of this year (2018) and ended up staying in the hospital for over a week. I lost all function of my legs, couldn't stop throwing up, could barely see or speak and I was just continuously going downhill. When I got to the emergency room I was still having all of these issues and they were getting worse.... I had to literally fight with the doctors to keep me because they were going to send me home, but I knew something wasn’t right. They ran so many tests and finally diagnosed me with Primary Addison’s disease, also known as adrenal insufficiency. 

Life after my diagnosis....

There are people who I thought would always be a part of my life, but when I was hospitalized and diagnosed some of the people I considered closest to me just disappeared from my life and I haven’t heard a word from them since... including some family. My BEST friend of 24+ years hasn’t checked on me or spoke to me once since then and it is absolutely heartbreaking.

Relationship problems started almost instantly after my hospital stay (thankfully they’re much better now). My boyfriend didn’t understand that some days I wasn’t going to be able to do all of the things I did before because I have to conserve my energy and I get worn out very quickly. We had many fights because he  thought I was just being lazy. He questioned my ability to be able to stay home and take care of our children like I had always done. He didn’t like when I talked about being sick because it was literally every single day I Was telling him how I didn’t feel good.... eventually he admitted that he was scared for me and mad that there was nothing he could do to help me, but it took us until recently to get on the same page and him to do research on my new condition that would change our lives.

Depression and guilt set in.... I felt, and still do on some days, like I was letting my children down because I can’t go outside and spend all day playing with them out there like I had done prior to my diagnosis. I felt like they deserved a better mommy, one that was healthy. I struggled with the harsh reality that there is no cure for my illness and I would have to be on medication for the rest of my life at the age of 27. I am working on dealing with these emotions, some days are harder than others, but I’m doing the best that I can.

I have been in and out of the hospital several times since my initial hospital stay. I have been sick more than I have been well. Physically and Mentally.

My life will never be the same, but I am thankful that I am alive.

Thank you for reading my story, if you have Addison’s disease I would love to connect with you since it is such a rare condition. <3

[woods2006gal]

The Born Again Identity

“You can’t just barge in here without an appointment,” the nurse says as Dean barges into the office. Addison shoots the nurse an apologetic smile. A balding middle aged man sat behind a desk. As soon as the hospital had called Dean, they both were in their latest car to go find Sam.

“They said ‘talk to Kadinsky.’ You Kadinsky,” Dean asks, ignoring the nurse.

“You need to be scheduled.”

“Well, then, schedule me,” Dean snaps. “He was in a car crash. Why the hell can’t we see him?”

“You’re Sam Smith’s family,” Kadinsky asks.

“Yeah, what’s going on?”

“It’s fine. Thank you,” Kadinsky tells the nurse. She shoots him a skeptically look. “Really.” The nurse glares at Dean as she walks out of the office. “Sam was admitted. He was treated for a broken rib and lacerations.”

“Well, that’s not too bad,” Addison says. “But that doesn’t explain why we can’t see him?”

“He’s on our locked psychiatric floor.”

Dean and Addison exchange a surprised look. “Well, I mean, he’s had some trouble—” Dean begins.

“So, you’re both aware that Sam is experiencing a full blown psychotic episode?”

“Psychotic? Come on. I mean, the guy’s…it’s not like the guy’s freaking Norman Bates.”

“I’m sure he isn’t. We need to determine whether his state was brought on by the insomnia or whether the insomnia is a symptom of his condition. Do you understand? So we can figure out how to treat him.”

“Well, all I can say is that the, uh, sleep thing is kind of new.”

Kadinsky sighs. “Right. Well, we’ve pumped him about as full of sedatives as we safely can. So far, he won’t go under. I’ve never seen anything like it.”

Addison glances at Dean. “Doctor, can we see him?”

“Follow me.” Kadinsky leads them through locked ward. He stops out side a room and they can see Sam sitting on a bed. He looked worse than the last time either of them had seen him. He was wearing the white pajamas that all the patients wore.

Addison enters the room and tightly embraces Sam as Dean quietly closes the door. “How are you feeling,” she asks, sitting on his bed.

“Maybe you should cancel my UFC fight,” Sam replies.

“Sam, we’re gonna find you help,” Dean says, sitting down next to Addison.

“I don’t think it’s out there, Dean.”

“We don’t know that.”

“We know better than most. It’s all snake oil. Last faith healer we hooked up with had a reaper on a leash. Remember.”
 “Yeah, Sam, I remember.”

“I’m just saying…”

“What? That you don’t want my help?”

“No, I’m just saying…don’t do this to yourself. Either of you.”

“Sam, if I don’t find something—”

“Then I’ll die.” Dean shakes his head and stands up. “Dean, we knew this was coming.”

“No.”

“When you put my soul back…”

“No.”

“Cas warned you about all the crap it would—”

“Fuck Cas,” Dean angrily snaps. “Quit being Dalai fucking Yoda about this, okay? Get pissed!”

Sam tiredly sighs. “I’m too tired. This is what happens when you throw a soul into Lucifer’s dog bowl. And you think there’s just gonna be some cure out there?”

Addison watches as Dean nods and walks out of the room. She hugs Sam once more. She presses a soft kiss against his cheek, then slips out of the room. ~*~ Addison yawns as she walks upstairs, clutching the heavy book. The past few days, her and Dean had been holed up in Rufus’ cabin, searching for anyway to help Sam. Dean had been calling every contact that he could find in John’s journal and that he found in Bobby’s journals. Addison had called everyone of Patrick’s contacts and had spent her time going through his books. “I think I might have found something,” she says, setting the heavy book on the coffee table. Beer cans fall to the floor. “It’s a transference spell. It would essentially take away everything Sam’s going through. I mean, we already have everything to cast it.”

“What’s the catch,” Dean asks, sitting down next to her.

Addison shifts. “Well, if I got the translation right, since we would be transferring it from Sam it would have to go into another person. It’s a sacrifice.”

Dean shakes his head. “No.”

“Dean—”

“No, Addison. We’re not sacrificing some innocent sap to be subjected to Lucifer.”

Addison takes a deep breath. “Or we put Lucifer in my head.”

Dean stares at her. “No.”

“Sam’s soul spent a year and a half locked up with Lucifer. A year of that is my fault. Because I didn’t call—”

“It doesn’t matter how long his soul spent in that damn cage, Addison. Sam would still be in the same damn position as he is in now. It’s fucking Lucifer. I’m not letting you put Lucifer in your head. We’ll find another way to save Sam.”

Addison sighs and picks up the book before standing. “Back to the drawing board.” ~*~ Dean runs a hand over his face as he scrolls down the website he had randomly found while researching. He glances over at where Addison was sitting at the table, eating a bowl of soup and looking through another book. They had barely talked since he had shot down her idea. His phone rings and he automatically picks it up. “This is Dean,” he answers, closing the website.

“Mackey,” a voice replies back. “Calling you back. Hey. Real sorry about Bobby.”

“Yeah, me too.”

“Look, what you called about…I might have something for you.” Dean perks up. “There’s this guy. He goes by Emmanuel. He kind of roams. First started hearing about him a couple of months back. How he was healing the sick, curing the crazy.”

“Uh huh.”

“Naturally, I think something in the milk ain’t clean. Find this sucker, punch his clock. Right?”

“Right.”

“Heard the best way to get to him is through his wife, Daphne, out in Colorado? So, I go. Tell her I’m going blind. It’s true. My right eye’s burnt out. She says, ‘Go home. He’ll come. So, I go. I set every trap, every test in the book.”

“That's what I would have done.”

“Emmanuel shows. He passes every one. There ain’t nothing weird about this guy. Except…he’s the real deal.”

Dean tightens his grip on his phone. He barely registers Addison standing next to the couch. “What do you mean?”

“He touched me and my eye was fixed. Look, I don’t believe in much that don’t suck your blood. But I wouldn’t call you on a maybe.” ~*~ Addison climbs out of the car with Dean and they exchange a look before walking up to the suburban house. She was skeptical about this Emmanuel guy. But since Dean considered it a lead that he was actually interested in, she hadn’t said anything. Dean knocks on the door and they wait until a man comes and opens it. “Hi. Uh, is this Daphne Allen’s house,” Dean asks. “I’m looking for Emmanuel.”

“Well, you found him,” the man replies, with a smile. “Daphne’s resting. If you don’t mind.”

“Oh, sure. Yeah, sure.” Dean moves back as the man steps out of the house. “Um, so, I was hoping, uh…” He trails off when he notices a woman tied up and gagged sitting in the living room. Addison takes a step back when the man’s eyes flash back.

The demon grabs Dean and throws him against the door. It then grabs Addison and tosses her over the porch’s side railing. “You were saying, Dean?”

“You know, I’d think twice. Or don’t you know that your boss issued a hands off memo?”

The demon laughs. “Please. What you have done for him lately? Roman’s head on a plate? No? Whatever Emmanuel is, Crowley is gonna want him. A lot more than he wants you these days.” The demon moves towards Dean and Dean quickly stabs him in the heart. He shoves the demon and starts down the stairs to help Addison. He stops when he sees a man helping her up.

The man looks between Dean and Addison, who can’t help but stare in disbelief at him. Standing in front of them was Castiel. Gone was his usual suit and trench coat. It had been replaced with a dark blue sweater and a pair of dress pants. It was clear that he had no idea who either of them were. “What was that,” he asks.

“Maybe we should go inside,” Addison softly suggests. Dean clears his throat and nods. Emmanuel  walks up the stairs and they enter house.

Emmanuel immediately moves over to Daphne and undoes the gag. “Did that creature hurt you?”

“I’m okay,” Daphne answers. Emmanuel unties the ropes and she immediately stands up. “But, Emmanuel, they were looking for you.”

“It’s okay.” Emmanuel and Daphne walk over to where Dean and Addison were standing. “I’m Emmanuel.”

Dean blinks and shakes Emmanuel’s hand. “Dean. I’m Dean. And this is Addison.”

“Thank you for protecting my wife.”

“Your wife. Right.”

“I saw his face. His real face.”

“He was a demon.”

“A demon walked the Earth.”

“Demons. Whack loads of them. You don't know about…” Dean trails off, realizing that Emmanuel had no idea about demons.

“You saw the demon’s true face,” Daphne says. She turns to Dean and Addison. “Emmanuel has very special gifts.”

Addison smiles. “Yeah, we’ve heard that Emmanuel can help people.”

“I seem to be able to help to a certain degree,” Emmanuel replies. “What’s your issue?”

“My brother,” Dean answers. ~*~ Dean clenches the steering wheel as he glances in the rearview mirror at a sleeping Addison. Emmanuel had readily agreed to help after Dean had explained about Sam. They were currently on their way to go see Sam. “So Daphne. That, uh, your wife,” Dean questions, breaking the silence that had settled over the car.

“She found me and cared for me,” Emmanuel answers.

“Meaning?”

“Oh, it’s a strange story. You may not like it.”

“Believe me, I will.”

“A few months ago, she was hiking by the river, and I wandered into her path, drenched and confused and unclothed. I had no memory. She said God wanted her to find me.”

“So, who named you Emmanuel?”

“Bouncy baby names dot com.”

Dean glances at him and nods. “Well, it’s working for you. Must be weird not knowing who you are.”

“Well, it’s my life. And it’s a good life.”

“Yeah, well, what if you were some kind of, I don’t know, bad guy?”

“I don’t feel like a bad person. So, your brother.”

“Sam,” Dean supplies.

“Sam. What’s his diagnosis?”

“Well, uh, it’s not exactly medical.”

“That should be fine. I can cure illness of a spiritual origin.”

“Spiritual? Okay. Someone did this to him.”

Emmanuel looks at Dean. “You’re angry.”

“Yeah. Dude broke my brother’s head.”

“He betrayed you, this dude. He was your friend?”

“Yeah, well, he’s gone.”

“Did you kill him?” Dean glances at Emmanuel. “I sense that you kill a lot of people.”

“Honestly, I don’t know if he is dead. I just know that this whole thing couldn’t be messier. You know, I used to be able to just shake this stuff off. You know, whatever it was. Might take me some time but I always could. What Cas did…I just can’t. I don’t know why.”

“It doesn’t matter why.”

“Of course it matters.”

“No. You’re not a machine, Dean. You’re human. Your friend’s name was Cas? That’s an odd name.” Dean shifts, but remains quiet. Emmanuel turns to look at Addison. Dean’s jacket was draped over her. “Is Addison your wife?”

“No. She’s…” Dean trails off. “She’s just a good friend.”

“Oh. You seem to care a lot about her.” ~*~ Addison groans as she climbs out of the backseat of the car and stretches. They had stopped at a convenience store, to pick up a couple of snacks. “Oh, hey. Just, uh, sit tight,” Dean says, turning to Emmanuel. “We’ll be right out, okay?”

“An angel with amnesia,” Addison mutters in disbelief as they walk into the gas station. She shakes her head as they enter the store. She makes a beeline for the chips as Dean pulls out his cell phone. Hearing the store door open, Dean looks up into the mirror. When the man strides towards them, he pulls out the demon killing knife and shoves Addison behind him. The demon lunges for him and Dean throws him into the beer cooler before stabbing him.

Addison picks up Dean’s now broken cell phone off the ground. “Come on,” he says, taking his broken phone and shoving it in his pocket. They start out of the small store, but stop when they find more demons.

“Great,” Addison lets out. Dean raises the knife and swigs at one of the demons. The demon easily blocks the hit and sends the knife flying across the floor. She lunges for the knife as the demon tosses Dean into the wall. One demon walks over to Addison while the other demon moves towards Dean. The demon easily tugs her up and Addison slams the knife into it’s heart. She pulls the knife out as the familiar orange light flashes within the demon.

“Emmanuel, you son of a bitch,” Dean says, pushing himself up.

“Emmanuel. Yeah, not so much.” The hunters turn to see Meg.

“Meg," Dean greets.

“Dean and Addison,” Meg dryly greets. “You guys got some explaining to do.” Addison looks between the two bodies on the floor and walks over to the door. She locks it and flips the open sign to closed. She pauses for a moment, the pulls down the window shade. “Rumors are really starting to fly about this Emmanuel fellow. My curiosity sure got revved up.”

“Just tell us what you want, Meg.”

“Imagine my surprise when I track him down and he’s snuggled up with the two of you. And he’s the spitting image of poor dead Castiel. So, Dean, what’s poor dead Castiel doing in that junker out there?”

“Christmas caroling.”

“Fun. But how’s he alive? Last I heard, he played God, went poof.”

“I don’t know. And neither does he, so you gotta keep it shut.”

“Oh, I do?”

“He doesn’t know that he’s Cas,” Addison clarifies as Dean walks past her.

“I know. Been watching you for hours. So, here’s the deal. You might remember Crowley and me were frosty back in the day? Well, times haven’t changed.”

“Good,” Dean coldly says, tucking a bag of chips in his jacket pocket.

“That hurts my feelings. I’ve been good to you, Dean.”

“No, you’ve been good to you, sweetheart.”

“Look. Right now, rumors of this wandering healer are strictly low level. But body count is getting high enough to change that. Folks start poking, they sniff angel dust.”

“And they start falling all over each other trying to tell Crowley.”

“Now, picture Crowley with his hands on harmless little amnesia Cas. Don’t get me wrong, I’m gonna burn that smarmy dick. My time’s coming. But right about now, my army of one situation is not cutting it. It’s cold out here, there’s a price on my ass and I need friends.”

“Yeah. I get that. But we ain’t it.”

“That’s where you’re wrong, Dean. Cause I’m here to help you two and that makes us friends.”

“Help, huh? You mean see if you can’t turn harmless little Cas out there into an angel sized weapon?”

“Like you’re taking him caroling. And by the way, you really want to keep going with no backup? Hey, I don’t trust you guys either. But I could really use Emmanuel. And he trusts you two. So for now, it’s in everyone’s best interests to hold hands and cross the street together, okay?”

Dean glances at Addison and she remains quiet. “We go straight to Sam. No detours.”

“Love it.” Addison hands Dean the knife and grabs a few snacks off the shelves. “You sure we wouldn’t be safer traveling with a full throttle angel? I could jog his memory.” Dean shoots Meg a cold look. “Kidding! We wouldn’t want to upset the poor guy.”

The three of them walk out of the store and across the street to where Emmanuel was waiting. “Her face,” Emmanuel says, backing up. “She’s one of—”

“It’s okay,” Meg interrupts. “We come in different flavors.”

“She’s a friend,” Addison explains.

“Meg. Just here for moral support. I mean, after all, we go way back.” Meg’s met with three disbelieving looks. “Dean, Addison, and me. Just met you, of course. But I think we’re gonna be good friends too.”

Dean rolls his eyes. “All right. Can we go?” ~*~ “This silence is very uncomfortable,” Emmanuel says, breaking the silence that had settled over the car since they had gotten back on the road. Meg was sitting in the backseat with a sleeping Addison. Emmanuel glances between the hunters and demon. “Is there something I should know?”

“I don’t know,” Meg responds. “Guys?”

“No,” Dean answers. “Meg has that effect. Awkward. You know?”

Emmanuel turns to Meg. “That must be difficult for you.”

“Dean’s making a joke, Emmanuel,” Meg clarifies.

“Oh.” A loud snore comes from the backseat and Emmanuel frowns, looking at Addison. “Is she okay?  I’ve noticed that she sleeps a lot. I can cure her sleep apnea for you.”

“Addison’s fine,” Dean replies.

Meg smirks. “She’s very special, isn’t she, Dean?”

Dean shoots a glare at the demon in the rearview mirror. “Addison is—”

“Awake and needs to pee,” Addison yawns. “So, can we pull over?” ~*~ Dean shuts off the car and climbs out of the car to join Addison, Emmanuel, and Meg as they overlook the hospital that Sam was in.  A group of people were standing outside the emergency entrance. “Oh, gracious,” Emmanuel comments.

“Damn it,” Meg says. “Demons.” 
“Lovely,” Addison says.

“All of them,” Dean questions.

“No grass growing under your feet,” Meg replies.

Emmanuel looks at Dean. “How many of those knives do you have?”

“Just the one,” Dean answers.

“Well, then forgive me, but what do we do?”

“Yeah, Dean. Got any other ideas how we could blast through that,” Meg mocks.

Dean turns to the demon with a hard look on his face. “Excuse us. Meg?”

“Oh for the love of,” Meg mutters as she joins Dean and Addison a few feet away from Emmanuel. “Sam’s in there. I know you’re enjoying the double dip with your old pal, but—”

“You think it’s that cut and dry,” Dean interrupts. “Really? You know what he did. And you want to tell him and just hope that he takes it in stride? He could snap. He could…disappear. Who knows?”

“I gather we know each other.” They turn to see Emmanuel right behind them.

“Just a dollop,” Meg replies.

“You can tell me. I’ll be fine.”

“How do you know? You just met yourself. I’ve known you for years,” Dean argues.

Addison takes a deep breath. “You’re an angel, Emmanuel.” She ignores the look of disbelief that Dean shoots her.

Emmanuel stares at Addison. “I’m sorry? Is that a flirtation?”

“No, it’s a species,” Meg explains. “A very powerful one.”

“They’re not lying,” Dean tells him. “Okay? That’s why you heal people. You don’t eat. I’m sure there’s more.”

“Why wouldn’t you tell me? Being an angel,” Emmanuel says. “It sounds pleasant.”

“It’s not, trust me. It’s bloody, it’s corrupt. It’s not pleasant.”

“He would know,” Meg states. “You used to fight together. Bestest friends, actually.”

Emmanuel stares at Dean. “We’re…friends? Am I Cas?” He’s met with silence. “I - I had no idea. I don’t remember you. I’m sorry.”

“You have the power to smite every demon down there,” Addison softly says.

Emmanuel turns and looks at the hospital. “But I don’t remember how.”

“It's in there,” Dean tells him, walking over to him. “I’m sure it’s just like riding a bike.”

“I don’t know how to do that, either,” Emmanuel says.  Dean runs a hand over his face. “All right. I’ll try.”

“This ain’t gonna go well,” Dean says after Emmanuel walks towards the hospital. Addison rolls her eyes, but joins Dean as they watch Emmanuel.

“I don’t know. I believe in the little tree topper,” Meg counters. They watch as one by one, Emmanuel places a hand on the demon’s heads and a white light flashes. Once he’s finished, they make their way down to the hospital entrance. “That was beautiful, Clarence.”

“Cas,” Dean asks.

“I remember you,” Castiel replies. He turns to face them. “I remember everything. What I did. What I became. Why didn’t you tell me?”

“Because Sam is dying in there.”

“Because of me. Everything. All these people. I shouldn’t be here.” Castiel turns and walks away.

“Cas! Cas,” Dean calls. He turns to Addison and Meg. “You guys stay here. Cas!” Dean runs after Castiel. “If you remember, then you know you did the best you could at the time.”

“Don’t defend me. Do you have any idea the death toll in Heaven? On Earth,” Castiel explains. He turns and stops to look at Dean. “We didn’t part friends, Dean.”

“So, what?”

“I deserved to die. Now, I can’t possibly fix it, so why did I even walk out of the river?”

“Maybe to fix it. Wait.” Dean opens the trunk of the car and pulls out Castiel’s trench coat. None of the blood had been cleaned off. He watches as Castiel pulls on the trench coat and disappears with a flutter of wings. He runs back to the entrance and frowns not seeing Addison. “Where’s Ads?”

Meg smirks. “Said something about you not being her boss and going to save Sam.”

Dean runs into the hospital. He catches up to Addison and grabs her arm. “Cas is going to help Sam. So, whatever the hell you’re thinking of doing, don’t.”

“I was going to check on him,” Addison says, pull her arm out of Dean’s grasp. She walks into Sam’s room, with Dean right behind her as Castiel appears with Sam. The younger Winchester looked worse than when they had last saw him a few days. His hand was wrapped up and he looked even more exhausted than before. Addison sits down on the bed and lightly grasps his hands.

“I tried,” Castiel softly says, walking out of the room with Dean. “But I can’t.”

“What the hell do you mean you can’t,” Dean asks.

“I mean there’s nothing left to rebuild.”

“Why not?”

“Because it crumbled. The pieces got crushed to dust by whatever’s happening inside his head right now.”

“So you’re saying there’s nothing? That he’s gonna be like this until his candle blows out?”

“I’m sorry. This isn’t a problem I can make disappear. You know that. But I may be able to shift it.”

Dean frowns. “Shift?”

“Yeah, it would get Sam back on his feet.”

Castiel moves to walk back into the room, but Dean grabs his arm. “Tell me what the hell Heaven’s natural protection means when it comes to the damn bloodline,” Dean quietly demands. “Sarah isn’t picking up the damn phone and Patrick didn’t leave us any idea as to what it means.”

“Addison can die. Heaven no longer offers the protection after anyone in the bloodline turns thirty-three.” Dean frowns, taking in what Castiel had just told him. He turns when hears Castiel walk into the Sam’s room. Castiel sits down on the bed, on the other side of Sam. “It’s better this way. I’ll be fine.”

“Cas, what are you doing,” Addison asks, rubbing Sam’s hand.

Sam flinches as Castiel leans in. “Now, Sam, this may hurt. And if I can’t tell you again I’m sorry I ever did this to you.”

They watch as Castiel places a hand on Sam’s head. A red light flashes from Sam’s head and slowly moves up Castiel’s arm. Sam gasps for breath. “Sam,” Dean asks, walking over to the bed.

“Dean,” Sam disbelievingly says. “Addison!” He pushes himself up the bed and stares at Castiel. “Cas? Cas, is that you?” They watch as Castiel stands up and slowly backs away. A look of horror was on the angel’s face. ~*~ Dean rolls his eyes when he sees Addison walk into the gas station’s men’s room. “Occupied,” he tells her. They had left the hospital that morning, leaving Castiel in the hospital. Meg had stayed behind, offering to protect the the angel. And it was something that he wasn’t comfortably with but it was too dangerous for Castiel to come with them.

“What did Cas tell you about the bloodline,” Addison questions. “And don’t act like you didn’t talk to him about it. I know you, Dean. I know that you asked.”

Dean tucks himself in and flushes the toilet before moving over to the sink. “He said that you can die. But that’s it.” He glances at Addison and finds her staring at him. “Ads—”

“I think we should put this whole bloodline thing in the case closed file,” Addison quietly interrupts.

“Okay.”