#Trauma and TMJ

[12blog]

Factors that can increase the risk of developing temporomandibular joint (TMJ) disorder include: family history, injury or trauma to the jaw, inflammatory joint conditions, teeth grinding or clenching, stress, misaligned bite, and certain dental procedures.

[helioshellion]

hi im bucky and welcome to my long list of kiryu and majima headcanons mostly revolving around health related stuff bc that interests me. ive talked about it before but ive been wanting to reveal my mastermind plans for them. ive vaguely alluded to these all in my fics like friday night and phanto. anyways heres a list. may range from mildly nsfw but in a more medical way not a sexual manner since idc about that sort of thing

KIRYU

So for Kiryu he is a trans man who forgets his t injections every day of his life. every time he gets out of prison he has to restart on it and every time he has to go through all the initial stages once again like an evil cycle of hormones.

He has extreme nerve damage in his hands/fingertips due to severe hypothermia suffered at the end of Yakuza 5, and therefore cannot feel in his hands anymore.

Also suffers from a migraine disorder.

He deals with a very prominent compartmentalization problem stirred by his ever-changing life stages. A sort of out-of-sight-out-of-mind mentality born out of his fear of losing absolute control over his life. This goes hand-in-hand with general low empathy.

This also results in an extremely flippant attitude towards both sex and romance. He is not committal at all and does not imagine himself settling down. He is a reserved person, but he doesn’t shy away from sex. He lives in Kamurocho, after all. He’s just mostly desensitized and is mostly neutral towards it as he gets older.

 Yes hes bisexual love wins. But he has a low opinion of the men in his life thinking them callous and more difficult than he wants to deal with. This increases with his age and the worse the villains get. He almost has a mentality of needing to Win and Be Won in regards to romance. He must Prove Himself, or someone else must prove themself to Him.

Oh yeah and TMJ sorry to his jaw.

His life is in constant disarray and his self-contained environments reflect this. His living spaces are messes. Ashtrays filled with countless stamped cigarettes and shelves lined with half-eaten food and beer cans. He doesn’t want to be regarded as sloppy but theres something in his brain that makes him struggle with Cleaning his own spaces. There’s something about his mind that likes the control he has TO mess up his own space.

He has several single-tooth partial dentures mostly in his molar area. he has one prosthetic canine tooth.

He is no-op in regards to his transition. T has shrunk his chest enough that it sags loosely. If you’re curious, he’s dry as a desert down there. sorry.

He doesn’t exactly have a circadian rhythm. He sleeps and wakes up whenever he wants, and his brain does not register Night/Day. Meaning he could sleep through an entire day and his brain will not register sunlight. This results in getting him up to be extremely. Extremely difficult.

Big one, he lives with something like CTE. (Chronic traumatic encephalopathy (double parantheses because this condition cannot usually be diagnosed while someone is alive)) Which exemplifies his already present suicidal ideation and depression. Out of anyone in the series Kiryu has taken some of the Worst bodily trauma over a LONG period of time. It has taken a toll on his body and mind.

MAJIMA

Oh boy!

Majima has a hormone imbalance ever since the hole. if you remember in my fic Phanto I alluded to him being completely impotent and sterile due to a castration in the hole. He has gynecomastia and hypothyroidism but has no qualms about it. He’s not dysphoric about it at all, and tries to stay extremely vigilant about his testosterone intake (tgel, needles scare him).

Because of the above he has little to no sex drive, not to mention the extreme trauma relations to it. He has complexes on top of complexes about it. So he just doesn’t do it.

He has a weak right knee, which is the one he uses to kick/attack as he’s able to use his stronger leg as support. His arms and legs are longer than his torso, and he has an extreme slouch, which presents itself as a very permanent slouch crease on his stomach fold.

He has a distrust of men, mostly older than him, and is not a cis man, although he doesn’t have the language to describe himself or his sexuality. He’s old and doesn’t feel the need to.

Blatantly, not even just a Me headcanon, but Majima does have a mentality of needing to be beaten in order to fall in line. In relation to pretty much everything in his life. It’s much stronger the younger he is, and weakens as he gets older, aided by his improving mental state. By 7′s time, and he is an emotionally healthy person. Hiccups are to be expected, but they’re nothing to shame or be ashamed for.

In Dead Souls he discusses needing to keep his hair cut at an exact measurement. He is a massive micromanager in regards to Anything at any given moment. His living arrangements are extremely empty and uncreative.

The younger him was extremely flippant about caring for his eye, which resulted in several infections and close calls. It’s one of the reasons he decides to get his eye exenterated when he’s older. Somewhat of a symbolic thing as he works through his trauma, letting go of this thing that has clung to him, Literally an Infection. He changes things up, and lives happier for it. He wouldn’t have been alive it hadn’t been for Nishida.

He is one of the most intelligent people in the. Yakuza Team or whatever. Regardless of his deteriorating memory issues, he reads like a motherfucker and can beat anyone in almost any mind-game.

This is a byproduct of not considering the Kiwamis (majima everywhere and majima construction) as canon, but my Majima is very heavily inspired by 1, 2, and the movie iterations of Majima. Meaning, he is not a generally “nice” person. He is extremely empathetic, and reads people very well, but he tends to hold these qualities over peoples heads when he’s younger. As he gets older, these qualities shift to more. Altruistic purposes. He isn’t nice, but he is an understanding person.

I also shift the timeline around to place his marriage with Mirei before the events of 0 to allow better, smoother story progression. And I’m not going to handwave away anything he did because oh yeah did he fuck up.

Speaking of relationships, if Majima were to ever, he would be Very Attached. He is monogamous by heart, and is more about mental connections over inherently sexual or romantic. He is a One-and-Done person. He isn’t flippant like Kiryu, and holds an extreme amount of value in loyalty and love. He is not one for more monetary romantic gestures. He values touching a lot more, but discourages touching HIM. He’s stone. He feels love in being the one to touch, and for his partner to Be touched By Him. And I’m not talking about sexual practices or anything. But if that did progress to that, expect similar results.

However, adding to that, he is not going to try to “make things work” in any way. He will walk away if requested, and he will walk away at the inclination of things Just not working out. He jumps to conclusions quickly, but it is for good reason. Knowing when to bow out keeps him alive.

Back to body stuff. He has dentures along his entire bottom jaw. His top teeth are very discolored from smoking, resulting in a visible difference between his top and bottom teeth.

And whatever here’s Kazumaji bullshit too because I am predictable.

They’re more friends than lovers, if that makes sense. Regardless of the amount of love shared between them, their lives are a long string of boats passing by. Their loyalty for each other is extremely strong, and underlying love does carry this, but they can’t exactly settle down anytime soon. Majima talks to him as a confidant, not as a lover, and Kiryu speaks to him the same. It’s almost more intimate in a way. Neither of them put up fronts when they’re alone. They are both private together, speaking to each other ways they’d never speak to anyone else.

If we’re on a scale, Kiryu is the more romantically affectionate one. He’s the one who thinks of dates, who thinks of kissing, who thinks of whatever else. Majima doesn’t initiate any of this due to his before-said complexes on top of complexes.

Yet, on the flip side, Majima is the one who could most easily fall into domesticity. It’s something he’s fantasized for himself ever since he was a boy, and something he cast aside immediately following the hole. He imagined a family impossible for him, and has attempted to cast aside that part of himself. But there’s no destroying Who you Are. He wants to be a tender person. Once Saejima, his strongest familial relationship, returns, he lets that side of himself regain a foothold in his brain.

This is both supported and contradicted by canon depending on the game, but I’ll settle on one. Despite Majima’s reservations and trauma, he is more trusting than Kiryu in a lot of situations. (In Yakuza 2: “There’s nothing wrong with putting your trust in a guy...”) Kiryu will tend to be cynical and have to be “won” in order for him to put his trust in you. Majima, however, will put his trust if he feels he can, but is very liberal with rescinding it.

Kiryu goes through a phase in his romantic relationship with Majima where he feels unwanted due to Majima’s low intimacy drive. The only way that’s resolved is by talking. There’s a lot of things they cannot get out of their relationship with each other, and that’s absolutely fine. They find other things to make it work.

On the flip side....... Kiryu’s revolving-door life results in Majima feeling cast aside again and again. It’s not that Kiryu thinks of hurting Majima, but his idea of romance is very different to Majima’s. He thinks he can just put on a new skin and live out an entirely different life as a different person. This is what causes their relationship to fizzle out time and time again. Their relationship is a very, very unstable wave. It’ll be strong, weak, whatever. The bottom line is that they’re never going to be able to reach that Perfect Meeting Point.

BUT this is all from Yakuza 1-6....Post 7, and I have no idea! Maybe they can try again and see themselves more successful due to their Very different life circumstances. Without the clan to hold either of them back, maybe they can make things work. However, I can’t imagine them ever making anything “”official”” as in calling each other boyfriend Or getting married. Their relationship is strange and tumultuous but they genuinely. wholeheartedly Love each other.

[doctor-loboto]

rambling headcanon thoughts that are ALMOST a fanfic, call it a fictoid and also can’t decide who the pov character is:

Crispin is really good at psychological manipulation. Not because he’s like some mastermind abuser but just because he grew up in unforgivingly harsh circumstances in the shitty school system of the Psychonauts universe’s equivalent of 1940s England. He’s tiny and his eyes aren’t good and he’s always just been kind of sickly and weird so he learned these skills to survive.

He didn’t MEAN to make Fred have a psychotic breakdown. He just… may have trash talked him a little aggressively for getting his ass kicked by someone who just came out of a prolonged catatonic episode. But he couldn’t have known that Fred had a huge inferiority complex from his overbearing parents who forced him to go to French camp all summer without doing anything about his panic disorder, among other sins. In Crispin’s opinion, it’s mostly the hospital’s fault for allowing a nurse to do one-on-one care with patients when he had a history of trauma.

Conversely, he’s also discovered that he knows exactly what to say to comfort Loboto when he’s triggered or having a meltdown. He knows to appeal to Caligosto’s ego as a scientist and his desire to be loved, which isn’t difficult because he’s been kind of obsessed with Loboto since they were in the hospital together. He was supposedly violent but usually acted like a sedated puppy except for the rare occasion that he had to be restrained. He was tall, and if Crispin got very close to his face he could just barely tell that he had deep scars and two different colored eyes, like a white cat. It made him look rather dashingly villainous (for the record, about a fifth of the androphilic staff thought he was handsome, three fifths thought he looked like an unsettling failed taxidermy project with too many teeth, and the other fifth thought it was gross to view patients through a sexual lens).

He gathered from their interactions that Loboto claimed to have been the only child in an incredibly abusive family who dug out his brains with an ice pick, that he had been in the system since he was eight years old and had been institutionalized more times than he could keep track of, that his parents forced him to have so many surgeries to correct his scoliosis and TMJ (he wasn’t sure what that meant and Caligosto’s explanation wasn’t terribly coherent), he got kicked out of dental school for his revolutionary ideas and then he started putting weapons in people’s teeth for crime syndicates, he had removed his own appendix and one of his toes while living in a trailer, he knew how to build military vehicles out of scrap metal. It all sounded like the ramblings of a schizophrenic, which wasn’t a deterrent. Crispin had become infatuated with less functional men; at least Cal didn’t have a debilitating drug addiction or a secret wife, as far as he could tell.

Then he talked to Fred during one of his lucid periods and, because Fred was highly medicated and not technically bound by medical confidentiality anymore, he learned it was all true. Or at the very least the ideas Loboto was trying to express were true. Apparently he had been a sort of celebrity in northern Oregon, a human cryptid who traveled between vacant storefronts and had a garage somewhere in the woods full of surgical equipment and half-deconstructed junk vehicles. He was known for posing as a licensed dentist and also for digging through landfills in rain boots and a stained floral sundress.

The two of them became as close as patients in a mental hospital are allowed to be, especially after Crispin displayed his ability to mortally psychologically wound any aggressive inmates with a tactically aimed insult. People, generally other men, would sometimes threaten or harass Loboto when he was too sedated to object. Maybe it was because he was visibly effeminate or just because they perceived the destructive force of his outbursts as a threat to their masculinity.

So obviously, Caligosto chose his favorite fellow patient to be his chief of staff when he became the new Head Doctor. He presented Crispin with a fresh extra-small floor nurse uniform from one of the only supply closets that hadn’t been burnt or flooded and put it on over his straitjacket, which he still needed to wear to discourage him from chewing his fingers (Loboto knew this was the best course of treatment because he was the Head Doctor and he had a lot of experience with compulsively ripping out pieces of his own flesh).

But! Crispin had other duties as the Chief Orderly besides watching the patients and guarding the elevator. They were implied. Loboto didn’t actually feel comfortable making them official, or mentioning them. It was just understood between them that Crispin would help him if he asked. Which was ideal, because Caligosto didn’t need help all the time, but he sometimes had bad days. He would usually have a dream he couldn’t really remember clearly and then as he woke up and went on with his life he would start sweating and trembling and feel unbearably sick and scared. It had been happening to him for his entire life, and he usually hid inside all day and maybe drank or took nitrous oxide and mostly just rocked back and forth a lot.

Now, however, he had a good hospital staff. Crispin slept on a mattress on the floor in what Caligosto called his bedroom, so he was usually already there when these incidents would take place. Otherwise he would ring an extremely grating alarm that he had salvaged from the administrator’s office. The volume felt appropriate for the intensity of his feelings.

Crispin was highly skilled at his job. He called Loboto “Doctor” and held his hand and let Cal lean against him even though it was awkward because he was such a large person, especially compared to Crispin. He reminded Loboto that he was safe and things were okay and he was the doctor now and was in control. It didn’t completely slow down his heartbeat or make his anxiety go away, but it made him feel a lot better, usually enough to eventually fall asleep from emotional exertion.

Even after getting “arrested” and readjusting to normal life as disabled adults (well, if one of the disabled adults is an extremely part-time technician for a government agency), Crispin still uses his abilities to comfort Loboto and encourage him to take care of himself. Cal is arguably less functional than him, and living together has made his issues with memory and executive functioning very obvious. But Crispin honestly doesn’t feel like the relationship is unbalanced; Cal needs a little extra help in daily life, but he’s incredibly protective of his Chief Orderly who has been promoted to Administrative Boyfriend and is always supportive. Thanks to Loboto, his finger tips look normal for the first time in decades. When he tells people about it he always says that the best doctor on the Pacific coast is in charge of his treatment and Loboto is always very flattered.

[fleurserenity]

Hi. My name is Hashimoto's. I'm an invisible autoimmune disease that attacks your thyroid gland causing you to become hypothyroid.

I am now velcroed to you for life. If you have hypothyroidism, you probably have me. I am the number one cause of it in the U.S. and many other places around the world.

I'm so sneaky--I don't always show up in your blood work.

Others around you can't see me or hear me, but YOUR body feels me.

I can attack you anywhere and any way I please.

I can cause severe pain or, if I'm in a good mood, I can just cause you to ache all over.

Remember when you and energy ran around together and had fun?

I took energy from you, and gave you exhaustion. Try to have fun now.

I can take good sleep from you and in its place, give you brain fog and lack of concentration.

I can make you want to sleep 24/7, and I can also cause insomnia.

I can make you tremble internally or make you feel cold or hot when everyone else feels normal.

I can also give you swollen hands and feet, swollen face and eyelids, swollen everything.

I can make you feel very anxious with panic attacks or very depressed. I can also cause other mental health problems. You know crazy mood swings? That's me. Crying for no reason? Angry for no reason? That's probably me too.

I can make your hair fall out, become dry and brittle, cause acne, cause dry skin, the sky is the limit with me.

I can make you gain weight and no matter what you eat or how much you exercise, I can keep that weight on you. I can also make you lose weight. I don't discriminate.

Some of my other autoimmune disease friends often join me, giving you even more to deal with.

If you have something planned, or are looking forward to a great day, I can take that away from you. You didn't ask for me. I chose you for various reasons:

That virus or viruses you had that you never really recovered from, or that car accident, or maybe it was the years of abuse and trauma (I thrive on stress.) You may have a family history of me. Whatever the cause, I'm here to stay.

I hear you're going to see a doctor to try and get rid of me. That makes me laugh. Just try. You will have to go to many, many doctors until you find one who can help you effectively.

You will be put on the wrong medication for you, pain pills, sleeping pills, energy pills, told you are suffering from anxiety or depression, given anti-anxiety pills and antidepressants.

There are so many other ways I can make you sick and miserable, the list is endless - that high cholesterol, gall bladder issue, blood pressure issue, blood sugar issue, heart issue among others? That's probably me.

Can't get pregnant, or have had a miscarriage?

That's probably me too.

Shortness of breath or "air hunger?" Yep, probably me.

Liver enzymes elevated? Yep, probably me.

Teeth and gum problems? TMJ?

Hives? Yep, probably me.

I told you the list was endless.

You may be given a TENs unit, get massaged, told if you just sleep and exercise properly I will go away.

You'll be told to think positively, you'll be poked, prodded, and MOST OF ALL, not taken seriously when you try to explain to the endless number of doctors you've seen, just how debilitating I am and how ill and exhausted you really feel. In all probability you will get a referral from these 'understanding' (clueless) doctors, to see a psychiatrist.

Your family, friends and co-workers will all listen to you until they just get tired of hearing about how I make you feel, and just how debilitating I can be.

Some of them will say things like "Oh, you are just having a bad day" or "Well, remember, you can't do the things you use to do 20 YEARS ago", not hearing that you said 20 DAYS ago.

They'll also say things like, "if you just get up and move, get outside and do things, you'll feel better." They won't understand that I take away the 'gas' that powers your body and mind to ENABLE you to do those things.

Some will start talking behind your back, they'll call you a hypochondriac, while you slowly feel that you are losing your dignity trying to make them understand, especially if you are in the middle of a conversation with a "normal" person, and can't remember what you were going to say next. You'll be told things like, "Oh, my grandmother had that, and she's fine on her medication" when you desperately want to explain that I don't impose myself upon everyone in the exact same way, and just because that grandmother is fine on the medication SHE'S taking, doesn't mean it will work for you.

They will not understand that having this disease impacts your body from the top of your head to the tip of your toes, and that every cell and every body system and organ requires the proper amount and the right kind of of thyroid hormone medication for YOU.....Not what works for someone else.

The only place you will get the kind of support and understanding in dealing with me is with other people that have me. They are really the only ones who can truly understand.

I am Hashimoto's Disease.

[turtletaubwrites]

Hi hiii! For the writers truth & dare ask game: 🛼 ⇢ describe your latest wip with five emojis 🍄 ⇢ share a head canon for one of your favourite ships or pairings 🏜️ ⇢ what's your favourite type of comment to receive on your work?

Hi!! Thank you, I love these 🖤🖤

🛼 ~ Describe your latest wip with five emojis:

👀😰🍻🤬🦾

🍄 ~ Share a head canon for one of your favourite ships or pairings:

Frobin! ~ Robin is one of my favorite characters, and the first time I watched One Piece ten years ago, I didn't see Frobin. I don't know if it's just that I'm older now, or if I'm just seeing the story differently after healing a bunch of trauma, but my head canon is that everything Franky did and said during Enies Lobby stuck with her. Her whole fucking reality shifted during that arc, separate from him. But his silliness, his compassion, and his selfless acts of protecting her and helping her crew, all of that carved a place in her heart for him. I think they end up having such a deep and chill sort of love that I can relate to now after 11 years of healing my own trauma while sticking with the same silly guy. I love them so much. Frobin Forever!!!! 😭😭😭

🏜️ ~ What's your favourite type of comment to receive on your work?

I have soo many, so I'm going to do three! 1. The comments that mean the most to me are about representation. I've gotten comments from people telling me how much it meant to them to read about someone who was ace or poly, someone with sexual trauma, vaginismus, tmj, hypermobile eds, chronic pain, etc. I know how much representation means to me, and when I was growing up (and still today) there were so many parts of myself that I never got to see. Every time I get a comment like this, it makes me feel so happy, and so grateful to have found such a wonderful community. It makes me want to learn more, so that I can become more inclusive in my writing. 2. I adore comments that share specific things that they enjoyed in my writing or story, that allow us to have a back and forth about their thoughts, or my intentions, etc! I spend so much time obsessing over my writing, so when I get to talk about it with someone it makes me soo happy 😭😭 (there's not a whole lot of irl people I can share this smut with, lol) 3. FERAL SMUT COMMENTS! Y'all are so fucking creative, and I can't count how many times I've cackled from some excellent thirst comments. Thank you so much 🙏🏼🙏🏼🙏🏼

[mythicalmyles]

honey i’m so sorry that’s happening. i was going through the same thing a while ago. it’s okay if none of those things work. just “taking a bath” doesn’t work with depression. some meds didn’t work for me either. it’s important to remember that meds don’t work for a lot of people. it’s okay to try new ones and switch them. i tried like three different ones and dosages before finding one that worked for me. it takes time to heal and im sure these people reminding you of your problems don’t make you feel any better. it’s okay to feel upset. i probably can’t make you feel different about yourself but i can say i’ve gone through that. so many people have and you are not alone. it’s very very hard to believe but it does get better. i’m sure you’ve heard that millions of times before, but it does.

as for the nicotine, it’s hard to get off that kind of stuff. habits are hard to break. i understand that. i was the same with sh. i don’t have much experience with that kind of addiction, but i can recommend nicotine gum and patches.

one thing that helped me when i felt like i was going to do something was remind myself how many people would miss me. how my dog would stand by the window wondering where i went because she didn’t understand. how my parents and friends would mourn me and miss me.

it’s okay to reach out for help and you’ve done so much already by getting a therapist. it’s okay to switch therapists. i had to go through about four before i found my right one.

you are doing amazing by letting these feelings out and it’s okay to feel this way. so many people care about you. i know it’s hard to believe but it will get better. it may take days, months, years, but it will. i know it’s frustrating and i know none of this might help but i want you to know there are people like you out there who are going through this.

additionally, you should add the suicide hotline to your phone, i did it and it’s a good emergency plan. one thing you can also try on tumblr is kokobot, it’s anonymous and it’s a whole bot about venting.

you’ve got this love. stay strong<33

Ive been on so many meds im not qualified to get weed legally in the uk i lost count of how many ive been thru and these ones do good.. but they dont always work and my drs just keep upping my dosage im on 350 quitiapine and 150 sertraline along with 100mgs of instant activate quitiapine and honestly if it werent for my bf and the animals i wouldve dipped a long time ago but ik no one will look after them as well as i do

Unfortunately im allergic to nicotine patches and i cant actually have chewing hum due to my tmj i tried the spray but it instantly made me throw yp everytime i tried it so i packed it in and it was our first day i felt shitty bc we went straight into my trauma (first person ive ever told what actually happened) so i was dealing w that after along w flashbacks shes rlly sweet though and was really kind to me it was just a heavy session

And funnily enough i have tried two hotlines and both hung up on me so that was gucci mane 💃 but thank you i really appreciate it and i hope you have a great day

[mihrsuri]

It turns out that I have jaw pain on one side of my jaw because Trauma Bullshit and frankly this is one of many things I never thought were CPTSD but apparently are (this flare up bought to you by my dad yelling at another motorist in the car :/)

(Also I think maybe some kind of TMJ might be going on because self massage targeted to that helps)

(Dentists send me into Dissociation Hell as does medical appointments and I have only just realised how badly so it’s like, genuinely what is the cost benefit)

(And yes that’s with going to female medical professionals they are great it’s just the entire setting etc. Not that men aren’t great just Trauma Bullshit On My Part)

[mcatmemoranda]

I have a pt who has apparent status migrainosus. But it's been resistant to sumatriptan. She said she had some relief with IV meds in the ED (I believe she got depakote or valproate). I wonder if it might actually be 2/2 temporomandibular joint arthritis, which she was diagnosed with a month ago. That's what my preceptor mentioned. So I looked up TMD on UpToDate:

Pathogenesis – Several factors can contribute to the development of temporomandibular disorder (TMD) symptoms, including temporomandibular joint (TMJ) trauma, poor head and cervical posture, differences in pain threshold and processing, and psychological factors such as depression and anxiety.

●Clinical manifestations – Symptoms of TMD most commonly include facial pain: a dull, unilateral facial ache that is constant but waxes and wanes in intensity and is typically aggravated by jaw motion. Other common symptoms include earache, headache (typically frontal or temporal and often radiating to the jaw), and jaw and TMJ dysfunction (eg, decreased mandibular range of motion, clicking with jaw movement, intermittent jaw locking).

●Evaluation and diagnosis – The diagnosis of TMD is based primarily upon the history, including the patient's constellation of symptoms, and compatible physical examination findings. For patients with more severe symptoms and those with persistent symptoms, we obtain imaging to rule out local pathology in the teeth and jaw bones; a panoramic radiograph or cone beam computed tomography (CBCT) are both reasonable choices. We advise against the routine use of a standard radiograph of the TMJ, as this study does not provide valuable information regarding dentition and mandibular alignment and symmetry.

●Initial management with patient education and self-care measures – For all patients with TMD, we suggest initial management with education and self-care measures (Grade 2C). This includes education regarding the natural history of TMD and counseling on optimal head posture, jaw exercises (picture 2 and picture 3*), and proper sleep hygiene, as well as avoidance of triggers (eg, oral behaviors such as nail biting, pen chewing) if these factors contribute to symptoms. There are limited high-quality data supporting the use of self-care and education in the treatment of TMD; however, given the lack of harm and the potential benefit, these interventions are appropriate for all patients.

*Isometric jaw exercises are particularly useful for patients with temporomandibular joint dysfunction syndrome. These exercises are performed by applying resistance with an open or loosely fisted hand. In the isometric jaw opening exercise, the patient begins with her mouth open about an inch. The resistance and muscle contraction are held for 5 to 10 seconds before relaxing. This is repeated five times per session. Exercises can be performed with moderate resistance applied several sessions per day, or with maximum resistance one session per day.

*The isometric jaw forward thrust exercise is performed by pushing the jaw forward against the hand, holding and then relaxing. This is repeated five times per session.

•Physical therapy for musculoskeletal causes – For patients with a prominent musculoskeletal component or cervical or shoulder symptoms, we refer for physical therapy evaluation and treatment.

•Oclusal (bite) splints as adjunctive therapy – For some patients with TMD, particularly those with prominent musculoskeletal symptoms or evidence of bruxism, occlusal splints fitted by a dental clinician can be used as an adjunctive therapy along with other TMD treatments such as physical therapy.

•Biobehavioral management for comorbid psychological conditions – For patients with comorbid depression, anxiety, and stress disorders, biobehavioral management is used as adjunctive therapy in TMD treatment.

●Adjunctive pharmacotherapy for persistent symptoms – For patients with persistent symptoms despite education and self-care, we use adjunctive pharmacotherapy concurrently with other treatments.

•For such patients, we suggest using a nonsteroidal antiinflammatory drug (NSAID) as first-line pharmacologic therapy rather than other medications (Grade 2C). We generally treat patients with a 10- to 14-day course of a long-acting NSAID (eg, naproxen 250 to 500 mg orally twice daily).

•For patients with tenderness of the muscles of mastication, we suggest treatment with a skeletal muscle relaxant in addition to the NSAID (Grade 2C). For most patients, we prescribe the muscle relaxant for 10 to 14 days only. However, some patients with persistent muscular pain may benefit from an additional week of treatment.

•For patients with persistent TMD symptoms that warrant continued adjunctive pharmacotherapy after two weeks of NSAID treatment (or three weeks for those patients taking additional skeletal muscle relaxants), we suggest treatment with a tricyclic antidepressant (TCA) rather than other therapies (Grade 2C).

●Interventional management for severe or refractory symptoms – For patients with TMD symptoms refractory to noninvasive management, referral to an oral and maxillofacial surgeon with experience in managing TMD is warranted. Treatment options for these patients include trigger point muscle injections, botulinum toxin injections, and intraarticular injections.

●Surgical referral for refractory symptoms despite nonsurgical interventions – For some patients, such as those who have structural anatomic pathology on imaging and persistent jaw locking severe enough to interfere with activities of daily living despite three to six months of nonsurgical management, we suggest surgical intervention rather than no surgery (Grade 2C). Although the specific surgery offered will depend upon the intraarticular disorder, such patients are unlikely to achieve adequate symptom control without surgical intervention.

[madrivervalleyicelandics]

Training horses that give you a headache is good for you, it turns out 🤓😅🧠😵‍💫

Sylgja is now in her 3rd (non-consecutive) month of formal training, exclusively R+ of course 🍪

In month 1, over the summer, I taught her the basics: emotional regulation, boundaries, expectations, vocal cues, & basic aids.

Month 2 was spent helping her diagonalize & land heel-first after years spent in defensive lateralization & toe-first landing, which we suspect began initially to protect a shoulder issue (now long-healed & no longer painful) sustained (most plausibly) during birth trauma. She does have one visibly funny rib which has been examined & is not painful now. Foals heal so well, it’s hard to know exact details, & she grew up free in the mountains of northern Iceland for her first 2 years with minimal supervision. That was a choice I made for her, believing it to be best, because it has worked well for my other foals and for so many horses in Iceland. It was not the best choice for this individual, however, & I am unlikely to raise more foals in Iceland after this experience - not because I think it’s BETTER to have constant supervision, but because I breed so few horses & really can’t afford to have injuries like this fly under the radar & become longterm maintenance problems if I can avoid it in the future. In this case, I have lived & learned & made a new choice for my own program going forward. Anyway.

Month 3, we are now doing what I normally would have done in month 1: putting the French classical aids together with movement to teach her to balance & travel in a variety of positions for optimum soundness, comfort, & strength.

She certainly has challenged me to expand my toolbox & approach things through new access points. Presented with shoulder atrophy, loss of ROM, a toe-first landing & a total loss of diagonalization, I expected to use French classical mouthwork techniques early on to help access her thoracic sling via freeing the hyoid & TMJ. Instead, she immediately demonstrated that she cannot comfortably carry a snaffle 😵‍💫 Back to the drawing board…

I’ve used various postural rehab exercises (some of which I learned from the #balancethroughmovementmethod have been particularly helpful especially early on!), & now have put the French style half-halt & shoulder control on neck rope cues, & put lateral flexions & action/reaction cues on the bitless bridle reins.

So far it seems to be working, & I’m liking the results!

Progress is slow, but her shoulders are improving steadily. Previously she could not travel forward with any bend, or any forelimb abduction. Instead she would stop, or step backwards, if asked to bend her neck or or abduct a forelimb while in motion.

I particularly treasure the 2-way communication we’ve developed. She confidently communicates “yes” when she likes something, as well as “no” when she can’t do something, & I believe her & find a new access point when she says no.

To me, that’s trust ❤️

[specterofyou]

How did the friends meet? and whats up with them and their whole business?

Justice and Rei knew each other long before the events of TRJ and TMJ. Eventually, Rei met Mint (if it were not for Mint enjoying Justice's company the group likely would never have formed, because Justice and Rei had a bit of an... incident that ruined their relationship [although it can be said of all relationships Justice has that there will be an incident that inevitably ruins it]) and some time afterwards the three met Akira and Atlas. Except, unlike in TRJ, the group aren't really friends in more than name and obligations (one of the big reasons why TRJ is a semi-canon prequel and has some correlations to the main game, most of them tied to Justice who actually remembers the events of that game unlike everyone else [due to spoiler reasons that are hinted at in-game]). Rei and Mint are friends, Justice and Mint are friends/lovers if you're on Justice's route, and Akira and Justice are 'friends' as in they routinely hang out but are not close to each other because they both view feelings as something off limits (Akira because he thinks it ruins his image, Justice because Justice thinks no one would want to stick around after Justice is open and honest about something). (Mention of death below the cut):

And after Atlas's death, their group of "this guy I know hangs out with this other guy and they're not too awful" turns into a group who stick together solely because of their shared trauma. What their 'business' is is kind of complicated to answer overall because it's a large portion of TMJ's plot. Each route is dependent on other routes to figure out just what is up with each of them (especially Justice's route). You get to find out what's up with certain pairings in an LI and their opposing/rival's routes (Justice and Rei are opposing routes, Mint and Akira are opposing routes and these are all written to complete the other story, tackling the same/similar topic per pairing in different ways). Concisely, I'd say the group is basically "throw all the people who'd be the worst for each other together, add supernatural forces that are both why all of them are there to begin with (and why some of them exist) but also why they are all in this mess, vendettas that can range from hundreds of years to the dawn of time, and with all of that you can watch everything fall apart in 4k UHD 240Hz" Anyways, sorry for the long answer! There's a lot I didn't get into here, but that's all 'find out when the stories get released' territory. And, why M.C. isn't really brought up here is while he does play an important part in each route, he's there to carry the routes along primarily (he's also not guaranteed to be a friend to the LI in the LI's route because of horrible conflict resolution skills).

(Thinking about it now, it's probably surprising to hear that the group is like this after TRJ but that is why TRJ exists. The ideal scenario where they're friends and not... uh... whatever they are in TMJ.)

[cantsleepcenter]

TIPS TO RELIEVE TMJ PAIN RELIEF |CANTSLEEPCENTER|

Getting yourself checked for TMJ pain could be an excellent idea if you have been experiencing prolonged headaches, jaw pain, or toothaches for some time now. Temporomandibular joints, or TMJ for short, are the joints that connect the skull to the lower jaw and hold it in place with the help of muscles and ligaments. It is possible for TMJ disorders to be caused by arthritis, trauma, or dislocation, and symptoms can include TMJ pain, ringing in the ears, and neck pain.For more information visit our website - https://cantsleepcenter.com

[cashthecomposer]

The other day in the bookstore, a child ran up to me and screamed into my ear as loud as they could. I have tinnitus from a concussion and this made my head spin, sensory overload out the wazoo.

This past week, I met with a neurologist who tested my memory (I've been having issues lately after the concussion), and she revealed two frustrating things: 1) apparently I am indeed on the autism spectrum, I always kinda knew but this was the first time a doctor said it to my face, and 2) apparently folks on the spectrum, with sensory integration and processing issues, have a harder time recovering from a concussion.

So obviously, I grimaced and covered my ears and shut my eyes. I nearly fell down bc when I close my eyes now I lose all sense of balance, so I opened them again, grimacing bc I was in physical pain. My TMJ started to flare horribly and my jaw locked shut bc I was clenching it so hard.

Apparently those physical symptoms, the balance and the jaw thing, are at least partially related to the stress associated with my brain's atypical response to things, so it's not an uncommon issue for folks on the spectrum to have to go through physical therapy in order to return to their normal after a concussion or similar upset or trauma. Which I currently am. And boy was this incident a setback.

Then the migraine started. On top of the sensory overload, I had a booming pain in my head as though someone was screwing a helmet into my temples, and the lights above my head started to feel even more impossibly bright, and the shitty music playing just bounced around my head like a rubber ball in a tile bathroom. You know, the sort of throbbing headache that's going to resound for 6+ hours.

I didn't get to sleep until 6 o'clock in the morning, the pain in my head was just too much. It's been several days and my sleep cycle is still fucked. It's 3:30 am right now.

I saw the kid, now laying on the ground, still screaming. Then I saw the mother.

I'm standing there with my hands on my ears and my face fixed in a grimace after this kid screamed mercilessly right into my ear.

When I went home, I had to lie down for the rest of the day with the lights off. I haven't been able to eat anything other than pureed food and smoothies for 4 days because chewing hurts. My tinnitus has been worse than ever.

This mom sees me, and says, "There's no need to look at her like that."

"She's autistic."

[sanjeevaniclinic]

What are the conditions treated with physiotherapy?

COPD, myocardial infarction, and cystic fibrosis are examples of cardio-pulmonary conditions.

Hand therapy is used to treat disorders such as trigger finger and Carpal tunnel syndrome (CTS).

Rotator cuff tears, lower or upper back discomfort, and TMJ

Spinal cord injuries, stroke, multiple sclerosis, Parkinson's disease, brain trauma, and vestibular dysfunction

Children with Cerebral Palsy and other developmental issues

Tennis elbow and other sports-related injuries

Urinary incontinence

For further information, consult Sanjeevani Physiotherapy Clinic one of the best Physiotherapy Clinic in Borivali

[tiralosidental]

Understanding TMJ Disorders: How a Specialist Dentist Can Help

Introduction

The temporomandibular joint (TMJ) is a complex hinge that connects the jaw to the skull, allowing us to perform essential functions like chewing, speaking, and yawning. However, when this joint becomes compromised, it can lead to a range of debilitating symptoms collectively known as TMJ disorders. In this comprehensive guide, we will explore the causes, symptoms, and treatment options for TMJ disorders, with a focus on the specialized care provided by TMJ dentists.

What are TMJ Disorders?

TMJ disorders, also referred to as TMDs, are a group of conditions that affect the temporomandibular joint and the surrounding muscles and tissues. These disorders can range in severity from mild discomfort to severe, chronic pain that can significantly impact an individual's quality of life.

Causes of TMJ Disorders

There are several potential causes of TMJ disorders, including:

Injury or Trauma: Accidents, such as a blow to the face or a whiplash injury, can cause damage to the TMJ and lead to TMD.

Teeth Grinding and Clenching: Bruxism, the involuntary grinding or clenching of the teeth, can put excessive stress on the TMJ and lead to inflammation and pain.

Structural Misalignment: Misalignment of the bite, or malocclusion, can cause the jaw to function improperly and contribute to TMD.

Arthritis: Osteoarthritis or rheumatoid arthritis can affect the TMJ, leading to pain and dysfunction.

Stress and Anxiety: High levels of stress and anxiety can cause muscle tension and tightness in the jaw, which can exacerbate TMD symptoms.

Symptoms of TMJ Disorders

The symptoms of TMJ disorders can vary widely from person to person, but some of the most common include:

Pain: Pain in the jaw, face, neck, or shoulders, often accompanied by headaches or earaches.

Limited Mobility: Difficulty opening the mouth wide or moving the jaw from side to side.

Clicking or Popping Sounds: Clicking, popping, or grinding noises when opening or closing the mouth.

Locking of the Jaw: The jaw becoming stuck in an open or closed position, making it difficult to move.

Muscle Tension and Spasms: Tightness or spasms in the muscles around the jaw, face, and neck.

Diagnosis and Treatment of TMJ Disorders

If you're experiencing any of the above symptoms, it's important to seek the care of a TMJ specialist dentist, who can properly diagnose and treat your condition.

TMJ Specialist Dentists

TMJ specialist dentists, also known as TMJ Treatment dentist or orofacial pain specialists, are dental professionals who have received advanced training in the diagnosis and treatment of TMJ disorders. These specialists have a deep understanding of the complex anatomy and function of the temporomandibular joint and the surrounding structures.

Diagnostic Process

To diagnose a TMJ disorder, a TMJ specialist dentist will typically begin with a comprehensive examination, which may include:

Medical and Dental History: The dentist will gather information about your symptoms, medical history, and any previous treatment.

Physical Examination: The dentist will examine the TMJ, jaw muscles, and surrounding structures to assess for any signs of dysfunction or inflammation.

Imaging Tests: The dentist may order imaging tests, such as X-rays, CT scans, or MRI, to get a detailed look at the TMJ and surrounding structures.

Treatment Options

Once a TMJ disorder has been diagnosed, the TMJ specialist dentist will develop a personalized treatment plan to address the underlying cause and alleviate the symptoms. Some of the most common treatment options include:

Occlusal Splint Therapy: The dentist may recommend wearing a custom-made oral appliance, or occlusal splint, to protect the teeth from grinding and clenching, and to reposition the jaw into a more optimal position.

Physical Therapy: A combination of exercises, massage, and other techniques can help to reduce muscle tension and improve joint mobility.

Medication: Over-the-counter or prescription anti-inflammatory medications, muscle relaxants, or pain relievers may be prescribed to manage pain and inflammation.

Bite Adjustment: In some cases, the dentist may need to make minor adjustments to the bite to improve the alignment of the jaw and reduce stress on the TMJ.

Botox Injections: Botox injections can be used to relax the muscles around the TMJ, providing relief from pain and spasms.

Surgery: In severe, refractory cases, the dentist may recommend surgical intervention, such as arthroscopic surgery or joint replacement, to address structural issues within the TMJ.

Conclusion

TMJ disorders can be a debilitating condition that can significantly impact an individual's quality of life. However, with the specialized care of a TMJ specialist dentist, individuals can find relief from their symptoms and restore proper function to their temporomandibular joint. By understanding the causes, symptoms, and treatment options for TMJ disorders, individuals can take the first step towards a healthier, more comfortable jaw and a better quality of life.

[drneerajchandrakerraipur]

Meet Dr. Neeraj Chandraker: Leading Maxillofacial Consultant in Raipur

Welcome to CFI Dental Clinic & Implant Center, where Dr. Neeraj Chandraker serves as a distinguished maxillofacial consultant in Raipur. Known for his expertise and commitment to patient care,Dr. Neeraj Chandraker offers comprehensive dental and maxillofacial services aimed at improving oral health and enhancing smiles.

About Dr. Neeraj Chandraker

Dr. Neeraj Chandraker is a highly respected dentist and maxillofacial consultant practicing in Raipur, Chhattisgarh. With a passion for dentistry and advanced training in maxillofacial procedures, Dr. Neeraj Chandraker has earned a reputation for providing exceptional care to his patients.

Expertise in Maxillofacial Consultation

As a maxillofacial consultant, Dr. Neeraj Chandraker specializes in diagnosing and treating conditions affecting the mouth, jaw, and facial structures. His areas of expertise include:

Oral and Maxillofacial Surgery: Surgical treatments for impacted teeth, jaw misalignment, and facial trauma. Dental Implants: Restoration of missing teeth using advanced implant technology. Cosmetic Dentistry: Enhancing smiles through procedures like veneers, teeth whitening, and smile makeovers. TMJ Disorders: Diagnosis and management of temporomandibular joint disorders that cause jaw pain and dysfunction.

CFI Dental Clinic & Implant Center

Located in the heart of Raipur, CFI Dental Clinic & Implant Center is equipped with state-of-the-art facilities and a dedicated team committed to providing high-quality dental care. Dr. Neeraj Chandraker leads a compassionate and skilled team that strives to make every patient feel comfortable and well cared for.

Comprehensive Dental Services

Dr. Neeraj Chandraker and his team offer a wide range of dental services to address various oral health needs:

Routine Dental Check-ups: Regular exams and cleanings to maintain oral health. Restorative Dentistry: Treatments such as fillings, crowns, and bridges to repair damaged teeth. Pediatric Dentistry: Gentle and caring dental care for children to promote healthy smiles from a young age. Emergency Dental Care: Prompt treatment for dental emergencies, including toothaches and broken teeth.

Patient-Centered Care Approach

At CFI Dental Clinic & Implant Center, patient comfort and satisfaction are top priorities.Dr. Neeraj Chandraker takes the time to listen to each patient’s concerns, explain treatment options clearly, and customize treatment plans to meet individual needs and goals. This personalized approach ensures that every patient receives the best possible care.

Schedule a Consultation

If you are looking for a trusted maxillofacial consultant or comprehensive dental care in Raipur, schedule a consultation with Dr. Neeraj Chandraker at CFI Dental Clinic & Implant Center. Experience expert care, advanced treatments, and a commitment to improving your oral health and smile.

For more information or to book an appointment, please contact:

CFI Dental Clinic & Implant Center Website : https://www.changingfacesindia.com/

E mail: drneerajchandrakerraipur@gmail.com

Phone Number: 9752995399

WhatsApp Number: http://wa.me/9752995399

Address: Govind Nagar Rd, Beside Axis Bank, Pandri, Raipur, Chhattisgarh 492001

Facebook : https://www.facebook.com/changingfacesinida/

Youtube : https://www.youtube.com/channel/UCR6ZlDn_5IWHhytI9AH9ttA?view_as=subscriber

Discover the difference with Dr. Neeraj Chandraker and his team at CFI Dental Clinic & Implant Center, where your dental health and satisfaction are our priorities.

[peakperformancechiropracticwny]

Unlocking Wellness: How Craniosacral Massage Can Help You

Introduction

Craniosacral massage is a gentle, hands-on therapy that focuses on enhancing the body's natural healing capabilities by addressing the craniosacral system. This system, which includes the membranes and cerebrospinal fluid surrounding the brain and spinal cord, plays a crucial role in maintaining the central nervous system's function. In this comprehensive guide, we explore the benefits, techniques, safety considerations, and practical tips for experiencing the transformative effects of craniosacral massage.

Understanding the Craniosacral System

Before diving into craniosacral massage, it's essential to understand the components and functions of the craniosacral system:

Anatomy: Includes the cranial bones, cranial nerves, spinal cord, and sacrum, along with the cerebrospinal fluid and meninges.

Function: Supports the central nervous system by providing protection, shock absorption, and a pathway for cerebrospinal fluid circulation.

Rhythmic Movement: Involves subtle, rhythmic movements known as the craniosacral rhythm, influenced by the production and absorption of cerebrospinal fluid.

Benefits of Craniosacral Massage

Craniosacral massage offers a wide range of benefits that contribute to overall health and well-being:

Pain Relief: Alleviates headaches, migraines, neck pain, and chronic pain conditions.

Stress Reduction: Promotes relaxation and reduces stress by calming the central nervous system.

Improved Sleep: Enhances sleep quality and patterns by inducing a deep state of relaxation.

Emotional Balance: Supports emotional well-being by releasing tension and promoting a sense of calm.

Enhanced Immune Function: Stimulates the lymphatic system and supports immune response.

Injury Recovery: Aids in recovery from injuries by improving circulation and reducing inflammation.

Conditions Treated with Craniosacral Massage

Craniosacral massage is beneficial for managing various physical and emotional conditions:

Headaches and Migraines: Provides relief from tension headaches and migraines by addressing underlying muscular and nervous system imbalances.

Chronic Neck and Back Pain: Alleviates pain and discomfort in the neck, shoulders, and back through gentle manipulation and release of tension.

Temporomandibular Joint (TMJ) Disorders: Improves jaw mobility and reduces pain associated with TMJ disorders.

Stress and Anxiety: Calms the nervous system, reduces cortisol levels, and promotes relaxation.

Post-Traumatic Stress Disorder (PTSD): Supports emotional healing and reduces symptoms of PTSD by addressing trauma stored in the body.

Techniques Used in Craniosacral Massage

Craniosacral massage employs gentle, non-invasive techniques to enhance the body's self-healing mechanisms:

Light Touch: Uses subtle, light pressure to manipulate the craniosacral rhythm and facilitate natural fluid movement.

Listening Hands: Practitioners use their hands to listen and respond to the body's subtle rhythms and restrictions.

Energy Balancing: Integrates energy healing principles to harmonize the body's energy field and promote balance.

Somato-Emotional Release (SER): Addresses emotional trauma stored in the body tissues through gentle manipulation and dialogue.

Joint Mobilization: Includes gentle movements to improve joint mobility and alleviate restrictions.

Safety Considerations

While generally safe, craniosacral massage requires consideration of certain factors for optimal results:

Certified Practitioners: Choose a massage therapist certified in craniosacral therapy from a reputable institution.

Medical Consultation: Consult with your healthcare provider before starting craniosacral massage, especially if you have medical conditions or recent surgeries.

Comfort and Feedback: Communicate openly with your therapist regarding comfort levels, sensations, and any concerns during the session.

Hydration: Drink water before and after the massage to support detoxification and hydration.

Choosing a Qualified Massage Therapist

Selecting a qualified therapist ensures a safe and effective craniosacral massage experience:

Certifications: Look for therapists certified in craniosacral therapy (CST) by recognized institutions.

Experience: Prefer therapists with experience in treating conditions similar to yours and positive client testimonials.

Communication: Ensure the therapist communicates effectively and listens attentively to your specific concerns and health history.

Comfortable Environment: Choose a massage center that provides a tranquil, supportive environment conducive to craniosacral therapy.

Preparing for Your Craniosacral Massage

Prepare for your craniosacral massage session to optimize its effectiveness and your comfort:

Hydration: Drink water before your appointment to support the body's detoxification process.

Comfortable Attire: Wear loose, comfortable clothing that allows easy movement and access for the therapist's gentle touch.

Empty Bladder: Use the restroom before your massage to avoid interruptions during the session.

Relaxation: Practice deep breathing or meditation techniques to relax your mind and body before the massage begins.

During Your Craniosacral Massage

Maximize the benefits of your craniosacral massage with these tips:

Feedback: Provide feedback to your therapist regarding pressure, sensations, and any discomfort during the session.

Positioning: Ensure you are comfortably positioned on the massage table, with support for your head and neck as needed.

Breathing: Practice deep, diaphragmatic breathing to enhance relaxation and optimize the flow of craniosacral fluid.

Stay Present: Focus on the sensations and subtle changes in your body to facilitate healing and integration of the treatment.

After Your Craniosacral Massage

Support the benefits of your session with these post-care tips:

Hydration: Drink water to continue supporting detoxification and hydration post-massage.

Rest: Allow yourself time to rest and integrate the effects of the massage, avoiding strenuous activities immediately afterward.

Monitor Comfort Levels: Pay attention to how your body responds in the hours and days following the massage, and contact your therapist if you have any concerns.

Schedule Regular Sessions: Consider scheduling regular craniosacral massage sessions to maintain balance, support ongoing healing, and enhance overall well-being.

Conclusion

Craniosacral massage offers a gentle yet profound approach to promoting wellness by addressing the body's natural healing mechanisms through the craniosacral system. By understanding its benefits, techniques, safety considerations, and choosing a qualified therapist, you can unlock the potential of craniosacral massage to enhance your health, alleviate pain, and promote emotional well-being.

In conclusion, craniosacral massage is a valuable therapeutic modality that can support your journey toward optimal health and wellness. By following the guidelines outlined in this comprehensive guide, you can make informed decisions to maximize the benefits of craniosacral massage and experience its transformative effects.