#chronic disease management in primary care

[doctornearme1]

[specialtyclinics]

Orthopedic Urgent Care For Sports Injury in Midland, TX | SCC Midland

Sports injuries can be frustrating and debilitating, but with appropriate treatment, you can recover and get back to your favorite activities. Orthopedic urgent care clinics offer specialized care for sports injuries, providing prompt medical attention and personalized treatment plans. By seeking medical help when necessary and taking steps to prevent injuries, you can improve your overall athletic performance and well-being.

Contact us for expert orthopedic urgent care for sports injuries without any hassle (432) 599-9580 Or https://sccmidland.com/ Or https://sccmidland.com/ortho-and-spine/

[a-shade-of-blue]

Masterlist of Vetted Fundraisers from the Palestinians who directly contacted me (5-9 October)

9 October

Myassar Ramadan (@mya-ram): Myassar is a 33-year-old aspiring dentist. She has 3 children under 12. She has lost friends and families. She is fundraising to provide for daily necessities, to rebuild, and resume her studies. (https://gofund.me/07640856) (#134 on @/gazavetters vetted list) (€30 raised of €100,000 goal)

Hala, Ali Elshurafi (@halamahmoud66, @sohaabdullah73): This campaign raises funds for two sisters and a brother who wish to evacuate out of Gaza. The sisters are high school students while the brother is a uni student. (https://gofund.me/b20496e1) (vetted by 90-ghost) (£441 raised of £30,000 goal)

8 October

Yahya Bkheet (@yahyabkheet-blog): Yahya is 33 years old and has 3 children all under the age of 10: Dima, Mira, and Anas. He has a sick mother. Their house has been destroyed and they have been displaced more than 10 times. (https://gofund.me/6b7be7a8) (vetted by nabulsi, #110 on @/gazavetters vetted list)

Ahmed Sadeq (@ahmed94sadeq,@hadeeladly97): Ahmed and his partner Hadeel were supposed to get married in December 2023. They have lost their house. They managed to evacuate to Egypt with Hadeel’s elderly parents who suffer from chronic diseases. He is fundraising to evacuate the rest of his family in Al-Mawasi, Gaza, as well as provide for basic needs. (https://gofund.me/f8792ac4) (shared by 90-ghost) (€116 raised of €70,000 goal)

Akram Aldwake (@akramaldwaik18): Akram is 18 years old. He is from a family of 5 and has a twin brother called Malek. Their house has been bombed and their 12-year-old cousin was killed. They had to dig their mother, sister, and one-year-old niece from under the rubble. Many of his relatives have been killed. Akram wish to evacuate himeself and his family out of Gaza and continue his education. (https://gofund.me/1494903b) (#138 on @/gazavetters vetted list) ($65 USD raised of $25,000 goal)

Hossam Muhammad Abu Sakran (@hosam2004): Hossam is from a family of 7. His 80-year-old grandfather was killed by a sniper. Their house has been bombed. They are now displaced in Deir al-Balah. (https://gofund.me/dec9ba4c) (#131 on @/gazavetters vetted list)

Amal Al-Haj (@amal-alhaj): Amal (28) and her husband Abdel have 2 children: Roland (6) and Omar (2). Amal has lost her father due to a delay in medical treatment. Her mother suffers from high blood pressure and arthritis. Amal also has 4 younger siblings: Abdullah (21), Rana (18), Hala (13) and Mahmoud (14). They wish to evacuate out of Gaza. (https://whydonate.com/en/fundraising/save-amal-and-abdel-nassers-family-in-gaza) (#135 on @/gazavetters vetted list, shared by @/bilal-salah0) ($114 of $15,000)

Ismail (fadingchildwitch): Ismail is a photojournalist. He is raising money to buy basic necessities (tent, food, water, medical care) for himself and his family. (https://chuffed.org/project/114849-ismails-urgent-plea, https://www.paypal.com/pools/c/98D6XwUY4x) (#7 on this @/gaza-evacuation-funds vetted fundraiser post) (€5 raised of $10,000 on Paypal, and $67 raised of $18,000 on Chuffed)

Aisha (@mostafa-4, @mostaf77): Aisha has 4 children. She is a a 45-year-old mother with diabetes and high blood pressure while her husband Mustafa cannot walk. Their eldest son (22) is a computer engineering student, her eldest daughter in high school, while their two youngest children are in primary school. (https://gofund.me/025e9fee) (#340 on vetted fundraiser list by el-shab-hussein and nabulsi, also vetted by association. Mustafa is the brother of @/noor4habil8 (#5 on @/gaza-evacuation-funds vetted list here)) (€183 raised of €50,000 target)

Abdelrahman Alostaz (@3bdulra7manosama): Abdulrahman was a uni student studying medicine. He wishes to complete his educationin Egypt and help his family in Gaza. (https://gofund.me/e71b85a4) (#4 on @/gaza-evacuation-funds vetted list here) (€1,850 raised of €30,000 goal)

Shadia Al-Habil (@shadiafamily): Shadia is 25 years old. She graduated with a degree in English and was working as a teacher while completing her master’s degree. Her younger brother Mohammed (17) and sister Rama (13) both contacted hepatitis. She is also living with her sister’s family, including their 2-year-old son.  (https://gofund.me/96181c05) (vetted by @/moayesh (vetter for @/gaza-evacuation-funds), promoted by @/gaza-evacuation-funds) (€1,030 raised of €70,000 goal)

7 October

Marah (@marahxx, marah-xx): Marah is married.40 members of her family have been killed in a bombing that destroyed her house. Her family now consists of 7 adults and 3 children. They wish to evacuate out of Gaza.  (https://gofund.me/fea514fc) (shared by @/bilal-salah0 (#132 on the verified fundraiser spreadsheet vetted by el-shab-hussein and nabulsi))

Nour Abuelreesh & Mohammed Al-Madani (@nour-gaza): Nour and Mohammed have 2 daughters, the oldest is barely 2 years old and the youngest only a few months old. They are fundraising to buy basic necessities like food, and to eventually rebuild. (https://gofund.me/397145df) (vetted by association as Nour is a sister of @/hamza-gaza (vetted by @/gazavetters and #91 on their vetted list, also vetted by association)) (kr14,695 SEK raised of kr500,000 target)

6 October

Mohammad Ayesh & Yasser Ayesh (@ayeshjourney, @moayesh): Yasser was born in the 2014 war and became hard of hearing due to the sound of missiles. He has undergone a cochlear implant operation. The device implanted has to be charged regularly, Yasser now goes for days without hearing because he is unable to charge the device. As a result, Yasser has been losing the ability to pronounce some words. Mohammed is raising money to repair Yasser's hearing device, for Yasser's speech therapy, and also to rebuild their family home. (https://gofund.me/649fd2d9) (This is Mohammad Ayesh’s family’s campaign, he is one of the vetters at @/gaza-evacuation-funds!) (£1,250 raised of £60,000 goal!)

Samah (@samah-h): Samah and her husband have two daughters (age 9 and 2), as well as a 6-month-old baby born during the war. Samah gave birth without anesthesia or medical supplies. Her husband is also responsible for his 3 siblings, one of whom also has a child. They wish to evacuate out of Gaza.  (https://gofund.me/c2ab5e0c) (vetted by association/ vetted by @/bilal-salah0! They are the relatives of @bilal-salah0 (#132 on the verified fundraiser spreadsheet vetted by el-shab-hussein and nabulsi)) (€649 raised of €80,000 goal!)

Khalil Halas (@khalil-92): Khalil’s family consists of 12 members. While displaced, the Israel army killed his mother and arrested his younger brother. His brothers Muayad and Muhammad are both seriously injured and require surgeries. Their home has been destroyed. They are fundraising to buy basic necessities and to evacuate out of Gaza. (https://gofund.me/42a958e3) (vetted by association! Khalil is a relative of @/salman-1990 (vetted by 90-ghost) and a tent neighbour of @/sara-97a (vetted by 90-ghost)) (€371 raised of €30,000 goal)

Mohammed Alhabil (@mohammed-blogs): Mohammed’s father and brother have been martyred. He has been injured in the bombing that killed his brother Omar, and may lose his leg forever. He wishes to evacuate out of Gaza to get the medical treatment he needs. (https://gofund.me/34639589) (vetted by association! Muhammad is the brother of @nohaibrahim-blog (#157 on verified fundraiser list by el-shab-hussein and nabulsi, and #169 and Butterfly Effect Project vetted list)) (€642 raised of €20,000 goal!)

Mahdi Jad Al-Haq (@moh26, @moh26666): Mahdi and his wife Elham have 3 children: Saeed (19), Ahlam (22) and Sherin (15). Their house has been bombed and they wish to evacuate out of Gaza. (https://gofund.me/94a9652c) (vetted by 90-ghost, vetted by @/gazavetters and #72 on their vetted list) (kr6,988 SEK raised of kr300,000 goal)

Iman Shaban (@transparentobjectlady): Iman has 5 children, the oldest is 15 and the youngest only 2. The children are suffering from malnutrition and scabies. They are fundraising to buy basic necessities.  (https://gofund.me/17ef495a) (#31 on @/gazavetters vetted list!) ($268 CAD raised of $50,000 goal)

5 October

Jana Abunaji (@janaabunaje): Jana is 11 years old and she has 2 younger brother ages 9 and 5. Their father was injured at the beginning of this war, putting him out of job. They are strugglign financially, and things are so bad her parents are getting a divorce. They have no water, support or medical care. (https://gofund.me/b7408ba3) (vetted by association! Jana is the niece of @ahmedmatatsblog (vetted by @/gazavetters and is #33 on their Gaza vetted fundraisers list)) (€36 raised of €50,000 target)

Hala Dawoud (@halakamak): Hala have 3 children: Osama (17), Lana (13) and Mohammed (9). Hala suffers from a severe and chronic disease called multiple sclerosis (MS) which affects his ability to stand and walk. The treatment she needs is not available in Gaza, and if she doesn’t get the treatment it can cause nerve damage and permanent disability as well as loss of bladder control and vision impairment. She needs to evacuate out of Gaza to get treatment! (https://gofund.me/61e85243) (#307 on the vetted fundraiser list by el-shab-hussein and nabulsi, #954 on Butterfly Effect Project vetted list!)

Asma El-Derawi (@asmadirsblog): Asma is a Medical Laboratory Technologist. She is from a family of 15, including 6 children, the eldest of whom is 10 years old while the youngest is only 2 years old. Her brother Mohammed (24) is a uni IT student while her brother Ahmed (18) is a high school student, both of whom have been prevented from graduating. Her 2 sisters have 6 kids in total: Hazar (10), Tala (8), Mohammed (5), Hayam (6) years, Ibrahim (2), Noor (2). They wish to evacuate. (https://gofund.me/bebe3734) (vetted by el-shab-hussein and is #220 on vetted fundraiser list by el-shab-hussein and nabulsi)

Jaber Al-Haj (@jaberfamily, @jaberhj): Jaber is an Applied Chemistry graduate. He is currently in Kuwait but his wife Muna and his 2-year-old son Hashem are trapped in Gaza. He is fundraising to bring his family to Kuwait and to rebuild the business he had with his brother Aboud. (https://gofund.me/cc2a0f13) (shared by 90-ghost. Also vetted by association. He is a friend of @/osama--basil-sh (Shared by 90-ghost. Also Vetted by association)) ($110 USD raised of $29,000 goal!)

Mounir Alanqar (@shamraed): Mounir is 19 years old and from a family of 7. She has 4 siblings: Rasha (22 and married), Rana (21 and married), Mohammed (16), and Sham (4). Her mother suffers from chronic asthma and does not have the medication she needs. Sham is suffering from skin rashes, diarrhea and vomiting because of the contaminated water. They wish to evacuate out of Gaza. (https://gofund.me/296390e2) (#8 on the @/gazavetters vetted list) (€1,656 raised of €35,000 goal)

Click here for my Google Doc with my complete masterlist of all the Palestinian gfm asks I've received, updated daily (along with other verified ways to send aid to Gaza).

How are gfm campaigns vetted?  See here, here, here and here.

See post here for other verified ways to send aid to Gaza.

Don't forget your Daily Clicks on Arab.org, it's free!!! and Every click made is registered in their system and generates donation from sponsors/advertisers.

[covid-safer-hotties]

Reference saved in our archive (Daily updates!)

Abstract Purpose: The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV2). The impact of the pandemic is becoming more apparent now on various tissues and body organs. Limited knowledge is present about the characteristics, duration, and long-term sequelae of ocular problems post-COVID-19 infection. The purpose of the present study was to evaluate and analyze the ocular problems occurring in healthcare workers after COVID-19 infection.

Material and Method: This was a cross-sectional survey study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna. The participants were healthcare workers who were exposed to COVID-19 infection ≥6 months back. A questionnaire was prepared. Responses were evaluated and analyzed. Patient consent and institutional committee permission were taken as per norms.

Result: A total of 210 healthcare workers who were infected with COVID-19 >6 months back responded with complete answers. The maximum number of respondents was between the ages of 31 and 60 (73.3%). The pre-covid ocular problems were present in 25% of the participants, especially in those having chronic diseases (such as diabetes, hypertension, or both). Post-ocular problems were faced by 60% of the participants, which was significant (P < 0.01). Dry eye, itching, and foreign body sensations were present in 60% of those facing ocular problems (P < 0.01). Ocular surface manifestations were more common.

Conclusion: A knowledge, understanding, and awareness about ocular problems and their long-term sequelae in post-COVID-19-infected patients will help in early diagnosis and better management of such patients.

[vishnubhagwat]

Comprehensive Health Checkups: Detect Problems Before They Start

In today’s busy world, taking care of our health often takes a back seat. Routine health checkups are essential for identifying potential issues early, before they develop into more significant concerns. At Shivaay Hospicare, Dr. Reema Solanki Chauhan, a highly experienced primary physician and Medical Director, is dedicated to offering comprehensive and affordable preventive care services that focus on early detection, personalized treatment, and patient well-being.

Recognized as the Best MD Physician Doctor in Vadodara, Dr Chauhan ensures that Shivaay Hospicare stands out as the Best MD Physician Hospital in Vadodara, providing exceptional care for individuals and families.

Why Preventive Care Matters

Many health issues—such as hypertension, diabetes, and chronic infections—develop silently over time, showing no early symptoms. Regular checkups can:

Detect problems early, enabling timely intervention.

Stop minor issues from turning into major complications.

Improve long-term health outcomes with affordable and accessible care.

Dr. Reema Solanki Chauhan brings over 14 years of experience in clinical practice, advocating for a patient-centred, holistic approach to healthcare.

Healthcare Services at Shivaay Hospicare

Dr. Chauhan at Shivaay Hospicare delivers a comprehensive selection of treatments and services suitable for individuals across all age groups. Whether it’s routine preventive care or managing acute or chronic conditions, the hospital ensures high-quality care under one roof.

General Health Services

Health Checkups (General)

Wellness Screenings for Men, Women, and Seniors

Vaccinations and Immunizations (including Travel Vaccination)

Electrocardiography (ECG) for Heart Health Monitoring

Chronic Disease Management

Diabetes Management (Type 1, Type 2, and Diabetic Ulcers)

Hypertension Treatment

Arthritis Management

Chronic Obstructive Pulmonary Disease (COPD) Treatment

Thyroid Disease Treatment (including Thyroid Issues in Children)

Infectious Disease Treatment

Dengue Fever, Malaria, and Typhoid Fever Treatment

Tuberculosis (TB) Management

Childhood Infections and Measles Treatment

Herpes Infection Treatment

Gastrointestinal Care

Abdominal Pain and Gastritis Treatment

Irritable Bowel Syndrome (IBS) and Gastroenteritis Treatment

Peptic/Gastric Ulcer Management

Constipation and Acute Diarrhea Treatment

Respiratory Care

Cough Treatment and Lower/Upper Respiratory Tract Infection Management

Bronchial Asthma Treatment

Nebulisation Services

Specialized Care for Common Conditions

Headache and Migraine Treatment

Joint and Muscle Problems

Skin Allergies and Rash Treatment

Hair Treatment and Acne/Pimples Treatment

Anemia Treatment

Gout and Fibromyalgia Treatment

Additional Services

Addiction Management

Dressings and Preoperative Treatments

Immunity Therapy for Overall Well-being

Female Sexual Problems Treatment

Bad Breath (Halitosis) Management

A Doctor Who Cares: Dr. Reema Solanki Chauhan

At the heart of Shivaay Hospicare is Dr. Reema Solanki Chauhan, a primary physician with a strong commitment to holistic and equitable healthcare. With degrees in MD (Physician), Industrial Health Certification, and an MBA (Health), Dr. Chauhan blends medical expertise with a deep understanding of patient needs.

Her specialties include managing hypertension, diabetes, and infectious diseases, along with offering preventive care services that improve quality of life.

Recognized as the Best MD Physician Doctor in Vadodara, Dr. Chauhan’s dedication to her patients has earned Shivaay Hospicare a reputation as the Best MD Physician Hospital in Vadodara.

“Preventive care is about staying one step ahead—detecting health concerns early and empowering patients to live healthier lives,” says Dr. Reema Solanki Chauhan.

Why Choose Shivaay Hospicare?

Affordable and Comprehensive Health Checkups

Comprehensive Care for Acute and Chronic Conditions

Personalized Patient Care from an Experienced Physician

Preventive Care Focus for Early Detection and Wellness

Holistic Treatment Approach to Target the Underlying Causes of Health Problems

Take Control of Your Health Today

Your health is too valuable to wait for symptoms to appear. At Shivaay Hospicare, Dr. Reema Solanki Chauhan guarantees that each patient receives the care and focus they are entitled to.

Book your Comprehensive Health Checkup today at the Best MD Physician Hospital in Vadodara and experience care from the Best MD Physician Doctor in Vadodara because early detection saves lives. https://g.co/kgs/7kxizNg

[alliedhealthahp]

Why Allied Health Is the Backbone of Holistic Healthcare Systems

In today’s rapidly evolving healthcare environment, the concept of holistic care has gained significant prominence. Holistic healthcare focuses on treating the whole person—mind, body, and spirit—rather than just addressing specific symptoms or illnesses. At the centre of this comprehensive approach lies allied health, a vital but often underappreciated sector of the healthcare system. Allied health professionals form the backbone of holistic care, offering a wide range of services that complement traditional medicine and enhance the overall quality of patient outcomes.

What Is Allied Health?

Allied health encompasses a diverse group of healthcare professionals who are not doctors, nurses, or dentists but who work collaboratively with these primary care providers to support patients. This field includes roles such as physiotherapists, occupational therapists, dietitians, speech pathologists, radiographers, and paramedics, among others. These professionals are highly trained in their respective disciplines and focus on prevention, diagnosis, treatment, and rehabilitation, ensuring that patients receive well-rounded care.

The Role of Allied Health in Holistic Healthcare

Holistic healthcare requires a multidisciplinary approach, and allied health professionals are uniquely equipped to address the diverse needs of patients. Their specialised expertise contributes to physical, emotional, and social well-being, ensuring that no aspect of a patient's health is overlooked.

1. Addressing Physical Health Needs Allied health professionals play a critical role in improving physical health. Physiotherapists and occupational therapists help patients recover from injuries, manage chronic pain, and regain mobility. These services are not just about fixing a problem but also about empowering patients to take charge of their health through exercise, education, and preventive strategies.

2. Supporting Mental and Emotional Well-being Holistic care also prioritises mental health, recognising the connection between emotional well-being and physical health. Speech pathologists and audiologists, for example, help individuals with communication disorders regain confidence and improve their quality of life. Similarly, social workers and counsellors assist patients in navigating emotional challenges, fostering resilience and stability.

3. Promoting Nutritional Health Dietitians are another key component of allied health, offering tailored nutrition plans that address a variety of health concerns, from weight management to chronic conditions like diabetes and heart disease. By focusing on dietary habits, these professionals empower patients to make sustainable lifestyle changes that support long-term well-being.

4. Bridging Gaps in Healthcare Access Allied health professionals often work in community settings, ensuring that healthcare services are accessible to all, including underserved populations. Paramedics, for instance, provide critical care during emergencies, while community health workers deliver education and preventive care in remote areas. This accessibility is a cornerstone of holistic care, as it ensures that every individual has the opportunity to achieve optimal health.

The Collaborative Nature of Allied Health

One of the defining features of allied health is its collaborative approach. These professionals work alongside doctors, nurses, and other healthcare providers to create a unified care plan tailored to the patient’s unique needs. For example, a patient recovering from a stroke may require input from a physiotherapist, speech pathologist, dietitian, and social worker, all working together to support their recovery journey.

This interdisciplinary teamwork not only improves patient outcomes but also enhances the efficiency of the healthcare system. By addressing various aspects of health simultaneously, allied health professionals help reduce hospital readmissions, shorten recovery times, and minimise healthcare costs.

Allied Health and Preventive Care

Preventive care is a cornerstone of holistic healthcare, and allied health professionals are at the forefront of this movement. Through education, screenings, and early interventions, they help patients identify and manage risk factors before they develop into serious conditions.

For example:

Physiotherapists educate patients on posture and ergonomics to prevent musculoskeletal issues.

Dietitians provide nutritional counselling to combat obesity and related diseases.

Speech pathologists offer early interventions for children with developmental delays, setting them up for success later in life.

By focusing on prevention, allied health professionals not only improve individual health outcomes but also contribute to the long-term sustainability of the healthcare system.

Challenges Faced by Allied Health Professionals

Despite their critical role, allied health professionals often face challenges, including limited recognition and funding. Many people are unaware of the full scope of services offered by allied health, leading to underutilisation of these resources. Additionally, workforce shortages in certain disciplines can strain healthcare systems and limit access to care.

Addressing these challenges requires increased investment in allied health education, public awareness campaigns, and policies that prioritise integrated care models. By supporting the growth and development of this sector, healthcare systems can fully harness the potential of allied health professionals to deliver holistic care.

The Future of Allied Health in Holistic Healthcare

As healthcare continues to evolve, the demand for holistic and patient-centred care will only grow. Allied health professionals are poised to play an even greater role in meeting this demand, thanks to their ability to adapt to new technologies, research advancements, and changing patient needs.

For example, telehealth has expanded the reach of allied health services, allowing professionals to provide care remotely and bridge gaps in access. Similarly, advancements in rehabilitation technology, such as virtual reality and robotic devices, are revolutionising the way allied health professionals deliver care.

Conclusion

Allied health professionals are the backbone of holistic healthcare systems, offering a wide range of services that address the physical, emotional, and social dimensions of health. Their collaborative approach and emphasis on prevention make them indispensable in creating a more inclusive, patient-centred healthcare model.

As society increasingly recognises the importance of holistic care, the role of allied health will continue to expand, transforming the way we approach health and well-being. By supporting and investing in this vital sector, we can ensure that healthcare systems are equipped to meet the diverse needs of individuals and communities alike.

[athena5898]

(PrR) Government Media Office (1/2):

The "israeli" Occupation’s Decision to Ban UNRWA Activities in the Occupied Palestinian Lands Represents a Historical Catastrophe and a Shock to Millions of Palestinian Refugees, and an Outright Challenge to the United Nations and International Law; We Demand the Expulsion of the "israeli" Occupation from International and UN Institutions.

The "israeli" occupation continues to commit numerous legal violations and acts of aggression against international resolutions, which are considered crimes in violation of international law. The latest of these actions is the occupation’s formal decision to ban the activities of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) in the occupied Palestinian lands, a move condemned by various countries and international organizations.

The occupation has officially notified the United Nations of its decision to cut ties with UNRWA, marking a historical catastrophe and a profound shock to millions of Palestinian refugees within and outside Palestine, who have awaited their return to their occupied lands since 1948, in accordance with international resolutions. This decision also constitutes a direct challenge to the United Nations and international law, undermining international legitimacy.

This dangerous, catastrophic decision by the occupation specifically targets the services UNRWA provides to millions of Palestinian refugees, including:

Targeting Educational Services: UNRWA operates an extensive network of schools offering primary, intermediate, and secondary education to Palestinian refugees, alongside vocational and technical training programs. UNRWA schools are among the most essential educational resources, providing free education to hundreds of thousands of Palestinian students.

Targeting Healthcare Services: The occupation’s decision targets health services provided by UNRWA, which operates health centers delivering primary care, preventive, and therapeutic health services to millions of Palestinian refugees. These services include vaccinations, maternal and child health, mental health care, chronic disease management, and more.

Targeting Relief and Social Services: The ban impacts UNRWA's social and relief services, which support the neediest families with food aid, financial assistance, and support for those living below the poverty line.

Targeting Infrastructure and Camp Improvement: The decision also impacts UNRWA’s infrastructure improvement projects in refugee camps, such as upgrading water and sanitation networks, developing roads and buildings, and enhancing the overall living standards within these camps.

Targeting Employment and Job Programs: UNRWA provides employment opportunities for refugees through operational programs and vocational training programs, enabling them to achieve self-reliance.

Targeting Psychosocial Support Services: The ban affects psychosocial support services for children and youth impacted by conflicts and displacement, including recreational and educational programs aimed at alleviating psychological stress.

Targeting Emergency Response Services: The decision will impact emergency response services in times of crisis and conflict, affecting the distribution of food and non-food items, as well as urgent medical care.

[edandstede]

In December 2023, Jordan Smitheman collapsed and died from an asthma attack. Now his mum Donna and the rest of Jordan’s family are campaigning to make inhalers free in England and you can sign their petition here:

In case you didn’t know, asthma medication such as inhalers are not free in England. I, like many others diagnosed with chronic asthma in this country, have to pay to breathe. Sounds inhumane because it is.

“Asthma accounts for 2-3% of primary care consultations. It impacts on everyday life such as education and work and leads to 60,000 hospital admissions and 200,000 bed days per year in the UK (NICE). Asthma attacks kill three people in the UK each day and every 10 seconds someone has a potentially life-threatening asthma attack.” Source: NHS England

In England, if you take diabetes medicine, you're entitled to free prescriptions for all your medicines, including medicines for other conditions. In England, if you have epilepsy and take epilepsy medicines, you are entitled to a medical exemption certificate which lets you get free prescriptions. Yet the same is not true for asthma, a lifelong respiratory disease with no cure that requires medication and regular checkups.

If I didn’t have my inhalers, I would die, and people can still die from asthma even when they’re taking medication. So why should anyone have to pay to breathe, to live?

Currently, I pay £111.60 for a 12 month prepayment certificate, which works out cheaper in the long-run for the cost of my monthly medications. If I didn’t have this, I would be paying £9.65 per item, and I currently have prescriptions for 2 asthma inhalers as well as a separate medication. If I need 2 inhalers a month, I’d be almost £20 out of pocket, and that’s without taking my other medication into account. If I use my reliever a lot that month and need an emergency inhaler - which has happened many times - that’s another £9.65 on top. It’s not cheap. Not everyone can afford it.

Jordan’s mum Donna says it best on the petition page:

“We believe that access to life-saving medication should be a right, not a privilege determined by one's ability to pay. We call upon the NHS and the government of England to make all asthma treatments free of charge. This will ensure that everyone suffering from this condition has equal access to necessary care and can manage their symptoms effectively without fear of cost.”

Please sign and share the petition. ❤️

[jcsmicasereports]

A contemporary clinical reasoning and multi-dimensional approach of Lower back pain management by Dr. Sarma S.T in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

The incidence rate of low back pain (LBP) is expanding in every clinical context as it is a common musculoskeletal illness affecting the overall population although the frequency of back pain and functional impairment increasing with age. This leads to tremendous strain as it represents one of the leading causes for growing disability and major socioeconomic burden in almost every healthcare system globally thus an efficient back pain management strategy is an urgent priority. This review is to outline the common causes, associated risk factors, clinical presentation and contemporary clinical reasoning including multi-dimensions of pain aspects to assess the patients with low back pain for achieving the precise clinical decision making as it would be a provision to implement potential tactics to lower the socioeconomic burden of this musculoskeletal disorder on the healthcare service providers.

Keywords: Biopsychosocial model, Clinical decision making, Diagnostic triage, Evidence-based practice, Lower back pain

INTRODUCTION

Lower back pain is a collective musculoskeletal illness affecting the overall population although frequency of back pain and dysfunction take place with aging. The previous research advocates that LBP occurrence increasingly takes place with aging and incidence may be recognized to work-related physical activities too. Population-based studies have indicated that LBP remains global concern thus it challenges every nation. The occurrence of LBP is 84%[1] as this common condition affecting individual at some point in their live consequently seen in both primary and tertiary care clinical settings. Moreover, the 1-year prevalence of LBP in aging people range from 13 to 50% similarly, up to 80%[2] experience this substantial musculoskeletal pain and follow long-term healthcare facility. If the LBP continues more than three months, this is considered to be as chronic lower back pain but there are number of studies advocate that chronic pain is lasting beyond the expected natural healing time period and neglecting the timeline-based classification. The differential diagnosis is crucial as it provides the underlying pathological causes because LBP is a disease not a symptom. The back pain represents one of the leading causes globally for growing number of disability and major socioeconomic burden in almost every healthcare system. According to the Global Burden of Disease Study evaluation revealed that LBP accountable for many years patient lived with disability[3]. Another study estimated that approximately 97% of people experience back pain at some time in their life while around 62% is mechanical nature or non-specific but between 5 and 10% of cases [4] develops chronic LBP then it seems to be the primary focus on seeking health care services. This eventually leads to a wider-range of negative consequences not only individual suffering from LBP but also causing negative impact on national levels. It minimizes the person’s quality of life due to personal suffering and subsequent economic impact on health care system. In the long run, LBP leads to disability in the working population and severely impacts on their productivity subsequently loss their working days. The resultant cost and absenteeism from work along with LBP is a serious social concern.[5] The LBP has a wider-range of potential etiologies and the LBP symptomatology can be overlapped each other also depend on the patient population but among the mechanical nature and non-specific causes are most common. However, successful outcomes of LBP are dependent on precise differential diagnosis. It can be reached by detailed clinical history taking, knowledge of the regional anatomy, precise understanding of the pathology comprehensive physical examination and diagnostic studies.[6] A number of clinical guidelines show that potential success of conservative management for LBP approximately 70% [7] although in certain cases are required surgical intervention. Thus, the efficient LBP management strategy is an urgent priority as the alarming rate of socioeconomic burden of this musculoskeletal disorder for nearly all healthcare service providers in every nation in worldwide.

ETIOLOGY

There is a wider-range of potential causative factors for developing LBP in every population although these etiologies depend on the patient’s medical history, examination and investigation. However, it is advocated that commonly mechanical or non-specific nature of LBP and among a large incidence of mechanical back pain due to lumbago, paraspinal hypertonicity, degenerative disease, facet joint and sacroiliac joint dysfunction while disc prolapse, inflammatory diseases, osteoporosis, malignancy, nerve root compression, canal stenosis and infection are all part of the differential diagnostic procedure.[8] Even though the majority of back pain is mechanical or non-specific nature and somewhere 12-33% [9] of people experience back pain due to either a true red flag like caudaequina syndrome then it need to be the immediate focus on medical management. At present, a growing number of researches contend that the pain occurs because of other aspect like cognitive behavioral factors, thus this dimension must be taken into the back pain diagnostic procedures. Differentiating the nociceptive pain from neuropathic pain and psychogenic pain is an essential step to make precise differential diagnosis as it is a high priority before initiating any therapeutic approaches.[10] The important trait of LBP management is identification of red flags to avoid delay of appropriate intervention and ensure patient safety.[11] It is vital to have comprehensive understand on clinical presentation of individual back pain cases and identifying the typical red flags associated with back pain such as loss of neurological functions, bowel or bladder incontinence and sleep disturbance could help to establish optimistic therapeutic management. There are several interventional approaches are being applied to cure the lower back pain suffering though the recent research report reveals that the majority of back pain cases resolve naturally with certain time duration.[12]

RISK FACTORS

A greater number of studies claimed that varying evidence related to job demands such as lifting and twisting with weight, ethnicity, genetic predisposing factors and mental health issues are all associated with higher risk of back pain although there is a few evidence provided that women have a greater risk of lower back pain.[13] A recent cross-sectional study claimed that there is strong correlation between lower back pain and obesity have a strong relationship as obesity is one of the risk factor to develop back pain subsequent functional disability. However, it is contended that the incidence rate of lower back pain is high when there is high chance of psychological issues.[14] In addition to that this study postulated that there is high prevalence of lower back pain among people with sedentary lifestyle thus they conclude that physical activity help significantly to decrease lower back pain perception. The varying level literature evidence and the lack of a homogenous definition of back pain lead to challenge for clinicians to have definitive conclusion in related to back pain scenarios though the global survey testify that it is varied geographically.[15]

CLINICAL PRESENTATION

The type of pain can be classified easily in case of having clear picture of mechanism of injury like bruise of skin or broken bone unfortunately there are some type of pain mechanism seems to be vague particularly incase of chronic lower back pain. The lower back pain is classified as acute when it persists for up to six weeks period and it is considered as sub-acute when it is prolonged for up to three months. If the pain is persisted beyond three months is considered as chronic lower back pain because 3 months period is commonly required to natural healing.[16] The back pain is usually defined as local pain, spasmodic muscle tenderness between below the costal margin and above the inferior gluteal folds with or without having leg symptoms. The acute lower back pain is often occurred as the result of tissue injuries and patients suffer from acute back pain are unlikely to follow medical care because acute pain gets better on their own or with conservative treatment. The majority of cases are non-specific and this non-specific chronic lower back pain management needs a huge financial burden to every healthcare system globally. The diagnosis and treatment for patients with low back pain have variation within and between country’s clinical practice guidelines.[17]

CLINICAL DIAGNOSIS

The clinical history taking and comprehensive clinical examination are the most important tools for assessing lower back pain to narrow down the potential root causes of lower back pain subsequently arriving precise differential diagnosis.[18] The goal of diagnosis in lower back pain is to describe the root causative factor of anatomic pain unambiguously as possible also concentrating on wisely classified clinical subgroups with the understanding of pain nature. This is essential to organize the appropriate clinical questions, active listening and mapping out the location of the lower back pain. These are the key areas in the medical history taking helps to identify the present pain location and any changes since its onset.[11] Also it is needed to find out easing and aggravating of pain factors because these are important keys to arrive a precise differential diagnosis. Thus, it is essential for clinicians to have clear understanding on the difference between somatic and visceral pain nature. However, if pain does not fit to any known diagnostic profile there may be other factors like psycho-social issues need to be considered.[19]

INTERVENTIONS

The biopsychosocial model has pragmatic clinical care guide to achieve potential prognosis among the chronic musculoskeletal pain cases. Unfortunately, the majority of healthcare providers follow the biomedical focused clinical practice. This approach relies on the structural model as it is generally assumed that the cornerstone of musculoskeletal pain management is governed by the structural changes in the human body.[21] However, the biopsychosocial model focuses on both biomedical element and potential psychological and social effect to analysis individual patient’s back pain. This would help to achieve the optimistic clinical outcomes with shared-clinical decision making with patient ideas, expectations and concerns rather than solely on clinician’s decision. According to the Institute of Pain Medicine, chronic musculoskeletal pain has been acknowledged as association of nervous system instead of completely relies on structural changes.[22]

CONCLUSION

Biopsychosocial model is concentrated a lot of effects on pain related psychosocial factors because people thought, feeling somatosensory experience and social dimensions contribute to development of pain. However, it is an enormous energy paid out to understand structural chances that relates to pain over the decades indeed still chronic musculoskeletal disorders are magnifying an alarming rate consequently burden to almost every healthcare system. Therefore, identification of psychosocial factors involvement and interpretation related to chronic musculoskeletal painful scenarios can contribute to implementation of cost-effective successful pain management strategies and innovation of drugs that help us to cut down socio-economic burden regard to chronic musculoskeletal pain. Therefore, it is essential to shift from biomedical structural model treatment approaches to manage chronic musculoskeletal pain by considering the psychosocial component in every contact of low back pain scenario. Therefore, practicing efficient multimodality chronic lower back pain management pragmatic approaches based on biopsycosocial model is an urgent priority to reduce the socioeconomic burden to almost every healthcare provider as a result of pain reduction, avoid fear of movement and minimize pain catastrophizing would be achieved far better off quality of life in lower back cases.

AUTHOR’S CONTRIBUTION

The author has critically reviewed and approved the final draft and is responsible for the manuscript’s content and similarity index.

ETHICAL APPROVAL

The authors confirm that this review has been prepared in accordance with COPE roles and regulations. The Institutional Review Board review was not required because of the nature of this review.

Declaration of patient consent There is no patients participation in this study thus consent is not required.

Financial support and sponsorship This review has not received any funding or financial support from third party of the public and commercial sectors.

Conflict of interest There is no conflict of interest.

[doctornearme1]

Doctors Clermont

Doctors Clermont, FL, offer a range of medical services to cater to diverse health needs. From primary care to specialized treatments, these professionals are dedicated to providing high-quality care to the community. Many local practices emphasize personalized attention and preventative care to ensure optimal health outcomes. Clermont's healthcare providers are equipped with modern technology and expertise to address various medical conditions.

Services: Preventive Care Chronic Disease Management

Acute Care

Women's Health

Men's Health

Geriatric Care

Website: https://www.doctornearmefl.com/ 

Contact:  (352) 810-4187 

Address: 3232 Citrus Tower Blvd, Clermont, FL, 34711

[specialtyclinics]

Neck and back pain?

Back and neck pain can make even simple activities difficult. We provide care to improve your spine health to help you return to the activities you love.

Our orthopedic surgeons at Specialty Care Clinics specialize in treatments for arthritis pain in your back and joints, herniated discs, sciatica nerve pain, chronic spine disorders and more. We start by listening to understand you and your health needs and goals. Then, we work to identify the cause of your back pain and deliver the care that’s right for you. Visit Specialty Care Clinics for more clinic services.

[healthcentersnearme]

Understanding Different Types of Health Centers: A Comprehensive Report

Quality healthcare is a fundamental right, especially for a less privileged population. Throughout the United States, health centers are serving important roles in delivering care to populations that would otherwise lack access to medical services. Did you know that there are actually various types of health centers designed to meet various needs? Read below to see what the different types of health centers do and how they work towards improving communities' health.

Community Health Centers (CHCs)

Community Health Centers (CHCs) are likely one of the most common categories of health centers. These centers give primary, integrated care to low-income and medically underserved populations. Be it in cities or rural locations, CHCs give quality health services, even to some in health professional shortage areas (HPSAs).

Common services of CHCs include:

Primary care

Dental care

Mental health and substance abuse

Vaccinations

Chronic diseases management

CHCs are patient-centered, providing any patient any time with the assurance that everyone will receive care regardless of ability to pay. The majority of CHCs operate off a sliding fee scale. What patients pay depends on their income.

Migrant Health Centers (MHCs)

Migrant Health Centers (MHCs) are tailor-made services to meet the specific healthcare needs of migrant and seasonal agricultural workers. Such workers often face major health issues due to their migratory lifestyle, hazardous conditions, and lack of easy access to consistent healthcare. MHCs fill in such gaps, ensuring that the vulnerable populations get necessary healthcare.

Services offered by MHCs include:

Primary and preventive care

Occupational health services

Chronic condition management education

Pediatric and maternal care

The MHCs play an important role in providing health care to workers and their families who may often be moving between different parts of the country and need to have access to continued care.

Health Care for the Homeless Centers

Homelessness can be related to extreme challenges to health services. Health Care for the Homeless Centers (HCHs) are organized for the needs of the homeless. In addition to medical services, they provide crucial support services aimed at assisting stabilization.

Services HCHs:

Primary Care and Preventive Services

Behavioral Health Treatment

Case Management and Social Services

Housing Assistance and Benefits

HCHs represent a comprehensive, integrated model of care that addresses both physical and mental health needs while helping patients access housing and financial resources.

Public Housing Primary Care Centers (PHPCs)

Public Housing Primary Care Centers (PHPCs) are located in or around public housing developments. These centers orient to providing care near where the majority of residents live, thus increasing accessibility in terms of convenience and affordability. Situated close to where people live eliminates barriers to care and makes services accessible to them because residents do not have to travel far.

Common services available at PHPCs:

Routine medical examinations

Vaccinations

Follow-up management of chronic conditions

Health instruction

These offer an important resource in the way of providing primary care and prevention services for those living in public housing.

School-Based Health Centers (SBHCs)

School-Based Health Centers (SBHCs) have emerged as an innovative approach to bringing health care to the school. Medical, mental health, and sometimes dental services are provided in these centers to the students, staff, and the community at large. To most of the students—mostly in low-income schools—it may be the only source of health care.

Services provided at SBHCs include:

Physical check-ups, immunization against common contagious diseases

Common illnesses and injuries

Psychological Counseling

Health education

Health centers directly provide care at schools; therefore, the students are kept healthy and ready for school.

Why Health Centers Matter

Health centers are crucial for the reduction of health disparities. They bridge gaps in healthcare access for populations who often fall between the cracks in traditional healthcare systems. Whether it is a Community Health Center in a rural area or a Healthcare for the Homeless Center in a city, these facilities are necessary for closing gaps in healthcare access.

How to Find the Right Health Center for You

Each type of health center serves a specific population, but all are available to any individual who requires care. To find a health center near you, use our Health Centers Directory to search for locations, services, and programs. Whether you require primary care, mental health services, or assistance in managing a chronic condition, you likely have access to a health center that can meet your needs.

Conclusion

Health centers are the backbone of accessible healthcare in many underserved communities. Knowing the difference between various types of health centers will help you make an informed choice about where to seek care. In any of these situations, these centers exist to provide affordable and compassionate care to you and your family, ensuring that no one is left without the healthcare they deserve.

[a-shade-of-blue]

New Gaza fundraiser asks I've received (7-8 October)

8 October

Yahya Bkheet (@yahyabkheet-blog): Yahya is 33 years old and has 3 children all under the age of 10: Dima, Mira, and Anas. He has a sick mother. Their house has been destroyed and they have been displaced more than 10 times. (https://gofund.me/6b7be7a8) (vetted by nabulsi, #110 on @/gazavetters vetted list)

Ahmed Sadeq (@ahmed94sadeq,@hadeeladly97): Ahmed and his partner Hadeel were supposed to get married in December 2023. They have lost their house. They managed to evacuate to Egypt with Hadeel’s elderly parents who suffer from chronic diseases. He is fundraising to evacuate the rest of his family in Al-Mawasi, Gaza, as well as provide for basic needs. (https://gofund.me/f8792ac4) (shared by 90-ghost) (€106 raised of €70,000 goal)

Akram Aldwake (@akramaldwaik18): Akram is 18 years old. He is from a family of 5 and has a twin brother called Malek. Their house has been bombed and their 12-year-old cousin was killed. They had to dig their mother, sister, and one-year-old niece from under the rubble. Many of his relatives have been killed. Akram wish to evacuate himeself and his family out of Gaza and continue his education. (https://gofund.me/1494903b) (#138 on @/gazavetters vetted list) ($15 USD raised of $25,000 goal)

Hossam Muhammad Abu Sakran (@hosam2004): Hossam is from a family of 7. His 80-year-old grandfather was killed by a sniper. Their house has been bombed. They are now displaced in Deir al-Balah. (https://gofund.me/dec9ba4c) (#131 on @/gazavetters vetted list)

Amal Al-Haj (@amal-alhaj): Amal (28) and her husband Abdel have 2 children: Roland (6) and Omar (2). Amal has lost her father due to a delay in medical treatment. Her mother suffers from high blood pressure and arthritis. Amal also has 4 younger siblings: Abdullah (21), Rana (18), Hala (13) and Mahmoud (14). They wish to evacuate out of Gaza. (https://whydonate.com/en/fundraising/save-amal-and-abdel-nassers-family-in-gaza) (#135 on @/gazavetters vetted list, shared by @/bilal-salah0) ($84 of $15,000)

Ismail (fadingchildwitch): Ismail is a photojournalist. He is raising money to buy basic necessities (tent, food, water, medical care) for himself and his family. (https://chuffed.org/project/114849-ismails-urgent-plea, https://www.paypal.com/pools/c/98D6XwUY4x) (#7 on this @/gaza-evacuation-funds vetted fundraiser post) (€5 raised of $10,000 on Paypal, and $14 raised of $18,000 on Chuffed)

Aisha (@mostafa-4, @mostaf77): Aisha has 4 children. She is a a 45-year-old mother with diabetes and high blood pressure while her husband Mustafa cannot walk. Their eldest son (22) is a computer engineering student, her eldest daughter in high school, while their two youngest children are in primary school. (https://gofund.me/025e9fee) (#340 on vetted fundraiser list by el-shab-hussein and nabulsi, also vetted by association. Mustafa is the brother of @/noor4habil8 (#5 on @/gaza-evacuation-funds vetted list here)) (€173 raised of €50,000 target)

Abdelrahman Alostaz (@3bdulra7manosama): Abdulrahman was a uni student studying medicine. He wishes to complete his educationin Egypt and help his family in Gaza. (https://gofund.me/e71b85a4) (#4 on @/gaza-evacuation-funds vetted list here) (€1,775 raised of €30,000 goal)

Shadia Al-Habil (@shadiafamily): Shadia is 25 years old. She graduated with a degree in English and was working as a teacher while completing her master’s degree. Her younger brother Mohammed (17) and sister Rama (13) both contacted hepatitis. She is also living with her sister’s family, including their 2-year-old son.  (https://gofund.me/96181c05) (vetted by @/moayesh (vetter for @/gaza-evacuation-funds), promoted by @/gaza-evacuation-funds) (€1,030 raised of €70,000 goal)

7 October

Marah (@marahxx, marah-xx): Marah is married.40 members of her family have been killed in a bombing that destroyed her house. Her family now consists of 7 adults and 3 children. They wish to evacuate out of Gaza.  (https://gofund.me/fea514fc) (shared by @/bilal-salah0 (#132 on the verified fundraiser spreadsheet vetted by el-shab-hussein and nabulsi))

Nour Abuelreesh & Mohammed Al-Madani (@nour-gaza): Nour and Mohammed have 2 daughters, the oldest is barely 2 years old and the youngest only a few months old. They are fundraising to buy basic necessities like food, and to eventually rebuild. (https://gofund.me/397145df) (vetted by association as Nour is a sister of @/hamza-gaza (vetted by @/gazavetters and #91 on their vetted list, also vetted by association)) (kr14,695 SEK raised kr500,000 goal)

Click here for my Google Doc with my complete masterlist of all the Palestinian gfm asks I've received, updated daily (along with other verified ways to send aid to Gaza).

How are gfm campaigns vetted?  See here, here, here and here.

See post here for other verified ways to send aid to Gaza.

Don't forget your Daily Clicks on Arab.org, it's free!!! and Every click made is registered in their system and generates donation from sponsors/advertisers.

See links below for my Masterlists of Vetted Fundraisers from the Palestinians who sent me asks for if you want to help more people! As well as resources for palestinian students if you are a palestinian student!

Masterlists of Vetted Fundraisers

Click here for my Masterlist for fundraisers from 13 - 25 July.

Click here for my Masterlist for fundraisers from 26 -29 July.

Click here for my Masterlist for fundraisers from 30 July - 1 August.

Click here for my Masterlist for fundraisers from 2 - 5 August.

Click here for my Masterlist for fundraisers from 6 - 10 August.

Click here for my Masterlist for fundraisers from 11 - 14 August.

Click here for my Masterlist for fundraisers from 15 - 18 August

Click here for my Masterlist for fundrasiers from 19 - 21 August

Click here for my Masterlist for fundrasiers from 22 - 24 August

Click here for my Masterlist for fundraisers from 25 - 28 August

Click here for my Masterlist for fundraisers from 29 August - 1 September

Click here for my Masterlist for fundraisers from 2 - 5 September.

Click here for my Masterlist for fundraisers from 6-10 September.

Click here for my Masterlist for fundraisers from 11-14 September.

Click here for my Masterlist for fundraisers from 15-18 September.

Click here for my Masterlist for fundraisers from 19-22 September.

Click here for my Masterlist for fundraisers from 23-26 September.

Click here for my Masterlist for fundraisers from 27-30 September.

Click here for my Masterlist for fundraisers from 1-4 October.

Resources for Palestinian Students!

Initiatives and resources to support Palestinian students, academics and universities:

This is a list of initiatives and resources for Gazan students seeking to complete their studies, including initiatives, resources, training and scholarships. See list here.

Scholarships for Displaced Palestinian students:

Putting this here for the palestininans who follow me: If you are a displaced Palestinian student looking to fund your education, this document lists the scholarships available around the world for displaced Palestinian students.

[messagefound]

equivalent exchange

finally getting around to posting some things

ft lilieve by @crashstanding

summary: Adam has been neglecting his tree for too long. Lilieve decides to take matters into her own hands.

             When Lilieve was gradually pulling fruits off her own tree, she heard crying. She could only think of one person who cried like that.

         “WHAT ARE YOU DOING, ADAM?” she asked, lowering her neck down to the lower rungs. He had his own tree, did he not? She knew for sure it was in deep need of care and trimming, and yet here he was underneath hers.

         He flinched away as if he were a child in trouble, but all he held in his hands was a single fruit with only a nibble taken out of it. A small thing, yet his body was shuddering with pain and fear.

         “DEAR, IT’LL GET CAUGHT IN YOUR THROAT THAT WAY,” she said, reaching down with her taloned hands that were nearly as big as him. “AND EVEN JUST A NIBBLE IS ENOUGH TO MAKE YOU WEEP. WHAT WERE YOU THINKING?”

         Usually, when that was asked, it wasn’t an inquiry of motivation. It was, instead, an accusation. It wasn’t meant to ask “why,” rather to tell one firmly to stop.

         Her tone of voice lacked that. Her counterpart was not one to do things clandestinely. He would’ve had a strongly felt reason to ignore his own tree for hers, and she would know what it was.

         It took him a moment to respond. Like it often did in times of great distress, his body seemed to grow sharper, yet paradoxically not in a physical sense. Nothing seemed to change outwardly, and yet if one were to look upon him, it would be like looking at a thorn. The brain registers it as small, yet an inherent danger to handle carelessly. Instinctually, you know what would happen if one were to be thrown into a patch of briars.

         Yet, knowing all of this, Lilieve cradled him gently in her clawed hands. He did not flinch at the sight of them, so she never flinched at the sight of him.

         “…it’s not fair,” he finally managed to drag out.

         “WHAT ISN’T?”

         “why is it that you have to take all my burdens for me” he said, fingernails digging into the flesh of the fruit. He did not have claws like her, but she had seen the way he looks at her before. He would ball his fists so hard in his barely restrained rage, his palms bloody with noticeable puncture wounds afterwards.

         He would never dare raise a hand against another, however necessary it would be. He simply wasn’t that kind of person. Even accidental harm is enough for him to melt.

         But he felt rage. He felt anger. He hated every second he did, but those feelings nevertheless existed.

         “but when I try to reciprocate,” he continued. “I can barely contain the deluge”

         Lilieve’s gaze softened.

         His body was small in comparison to hers. She needed the added mass to contain her children, countless as they were. Her body served as a trunk to support the leaves. Her claws were for gouging and tearing at anyone who would dare hurt them. She was built to be an apex predator, the living manifestation of survival instinct. She had carried her children’s burdens by herself for years, long before her counterpart stumbled sleepily out of the woods. It was in her instincts to endure.

         Adam was not a creature meant to endure. He was left by himself for a time that to her seemed brief but for him was excruciating. All of what he loved had rotted away by the time he began to Remember. He still wished to love, to share himself, to give his sons the life they deserved. He knew no one deserves to have nothing. No one deserves to have everything they ever cared for stolen in a haze of ash and silence and hate. Silence was anathema; hate was the chronic wasting disease.

         But this left him vulnerable. You can show as much compassion as you physically can, but that doesn’t mean it will be reciprocated. The primary weakness that came with rebirthing the world and refusing to be worshipped for it was that no one will remember you did such a selfless act. Those few that did might even resent you for it. How dare you, how dare you restart this ugly, broken world’s heart? How dare you bid me live when all I wanted was to die? Not only do I not deserve your love, but you also don’t deserve mine.

         It didn’t help that a certain very strong example of that had happened recently.

         Her counterpart was a kind man, but he was absorbent, like moss. He internalized all that he saw, all the vitriol that still existed in the wake of his burial. It was no wonder that in recent days his tree had grown rampant and unkempt. He needed to share it, because that was the only way to prevent himself from buckling under the weight.

         Lilieve never minded. She could carry his burdens too. Anything for him, anything to make him feel less alone. He made her feel less alone, this was only fair exchange. This was only love. She drank his tears before; she could do it again.

         But he couldn’t drink her tears anymore. It became too much for him, drowning as he was in the wake of his spider lily’s death. He did it to clear his black eye, yes, but he still didn’t want to leave Lilieve alone. Even in his grief, he didn’t want to ignore her.

         His eyes were waterfalls then, as they were now.

         She turned her gaze to his tree, looking less like any tree that had ever existed and more like a rat’s nest at this point. That was fine.

         With him still in her hands, she lunged down, grabbing the entirety of the tree in her maw. The bark crunched between the jaws of her beak; the fruits already mashed into pulp by the force. Tipping her head back like an eagle with some salmon, the entirety of the deciduous wreckage disappeared down her throat.

         Adam was momentarily stunned out of his spiral at the sight.

         “what” he sputtered out. “what on earth?!”

         The incredulous look on his face, along with the way his voice left its despondence quickly behind, amused her immensely. She let out a rumbling warble, even as the emotions within the fruit stung her eyes and made them drip.

         “What on earth was THAT for, Eve?!”

         “EQUIVALENT EXCHANGE.”

         “I wouldn’t exactly call that equivalent!!!”

         “ONE FRUIT OF MINE IS ENOUGH FOR YOU. AND THAT IS OKAY.”

         “But…”

         He glanced back at the fruit in his hands.

         “…I still couldn’t share it. Not properly. Not how you would want.”

         “HOW DO YOU THINK I WOULD WANT IT?”

         He paused, glancing away. He seemed sheepish now, once again like a scolded child.

         “HM.”

         She pressed her beak against his cheek, making a kiss noise. He whimpered in response, clinging to her beak with a pale shaky hand.

         “IF YOU WISH TO SHARE, I WILL BE HERE TO SUPPORT YOU. IT’S OKAY IF YOU CRY. I PROMISE IT IS.”

         Her gaze turned sorrowful for just a second.

         “I KNOW IT’S A LOT. NOT JUST FOR YOU, BUT FOR ANYONE.”

         Adam paused once more, leaning against her beak.

         “I want to share,” he said. “Because it’s you…and it’s not fair that you should carry all of mine while I don’t carry yours.”

         “YOU CARRY MINE IN DIFFERENT WAYS. YOU KNOW THIS.”

         “Still…”

         “HUSH.”

         She kissed him again and tousled his hair in a manner reminiscent of preening.

         “GIVE THE FRUIT TO ME.”

         He did so, and she gently took the tiny fruit into her beak. With an effortless movement like the shutting of a vice, she bit it directly in half. She jostled one piece back into his hands, while the other went down her gullet.

         “WILL THAT BE EASIER?”

         He stared at it.

         “…it might.”

         There was silence.

         She gazed at him intently.

         “DON’T WORRY ABOUT CRYING AGAIN. I PROMISE IT’S OKAY. I’M HERE.”

         His jaw set. His fingernails dug into the piece once again.

         With an act entirely unlike him usually, he proceeded to tear into the fruit like a vulture into a carcass. The burden hit him almost immediately in response, with tears streaming down his face and the sharpness of his form returning, but he didn’t stop. He just kept tearing into it, only stopping to breathe deep sobbing gasps before rapidly resuming.

         Lilieve was afraid a piece would get stuck in his throat with how quick he was going.

         Eventually nothing of his piece remained. Not even a pit. Was there a pit? The pit only existed when one wanted it to.

         He shuddered, heaving out another sobbing gasp before collapsing completely.

         “DEAREST…”

         He screamed out another sob, muffled by her palms.

         “it’s not FAIR that you have to FEEL all of this by yourself”

         “I KNOW.”

         “it’s not FAIR that the children have to feel this”

         “I KNOW, DEAR.”

         “it’s not…it’s not…”

         His voice dissolved into watery noises.

         It made Lilieve’s heart hurt.

         Gently, she lifted his face up using her beak. With the utmost care, she placed it near his eyes, drinking deep of the waterfalls.

         He looked at her with one wide eye, questioning. His teeth were gritted, but he held onto her tightly.

         She smiled, even as her own streams were beginning.

         “Equivalent exchange.”

[p0litemenace]

Link to donate to GoFundMe

God, making posts like this is not easy. But here goes nothing.

First and foremost, thank you for taking the time to read this. Very recently, I was dealt two medical setbacks within the same week. Posting this is extremely difficult and violates every single safe feeling in my body when it comes to asking for help, but I’ve also reached an impasse where I don’t have any other choice but to reach out to my community and be vulnerable.

I am attempting to raise approximately $4,400 to address the following medical needs

1. Time sensitive dental care

To resolve advanced, time sensitive tooth decay, including fillings and crowns.

I am currently utilizing CareCredit to cover the upfront out-of-pocket costs of dental care.

I am resolving these issues to be eligible for surgery ASAP, per the advisement of my care team (see details below)

Estimated cost of this care is approx $2,200 post-deductible; I have paid for approx $1,500 of the treatments at this time via CareCredit (receipts posted below)

2. Parathyroidectomy (surgery)

I was recently diagnosed with primary hyperparathyroidism (PHPT). First-line treatment for PHPT is surgical intervention (parathyroidectomy).

Estimated cost of this surgery is approx $2,200 post-deductible. These are based on estimates via UHC for the in-network team I’ve selected.

With PHPT, I experience chronic pain of the joints, muscles, and bones, as well as additional side effects such as extreme fatigue, brain fog, depression, anxiety, constipation, and nausea.

For those familiar with PHPT, I have PTH levels of 185pg/mL (normal 10-65pg/mL), calcium levels of 11mg/dL (normal 8.5-10.5 mg/dL), and a left adenoma roughly the size of a bean, per my 4DCT scans (for context, a normal parathyroid gland is no bigger than a grain of rice). I have likely had this adenoma for over 5 years and desperately need to remove it to vastly improve my life and tackle chronic pain and fatigue, for which I've been having weekly physical therapy to help mitigate.

I have likely had this adenoma for over 5 years and desperately need to remove it to vastly improve my life. Receiving first-line treatment is extremely necessary in ensuring I do not develop osteoporosis and/or kidney disease further down the line.

Unfortunately, I have increasing credit card debt, making the payments to CareCredit extremely challenging to manage due to the high interest rates I currently have on other cards. I have accrued these charges due to a combination of life hardships, prior medical debt (previous dental work), and the overall high cost of living.

My ultimate goal vis-a-vis this GoFundMe is to pay off my CareCredit card to fulfill these medical needs, then through NFCC (National Foundation for Credit Counseling) work with a counselor to (1) close my credit cards and (2) lower my interest rates. I cannot close my credit cards and begin to properly manage my debt until I have fulfilled the medical needs I have.

For additional context about me, as of right now I have a full-time job in operations. I am also neurodivergent (AuDHD) and have always struggled with financial literacy. In full transparency, I have made financial mistakes along the way that I cannot undo, mistakes which are all catching up to me at this point in time.

I find due to these mistakes and due to life hardships I have no control over, it is getting harder for me to keep up with the day-to-day costs of living, including buying essential groceries, paying rent, and paying my utilities. If I can tackle this medical debt, I truly believe I will get ahead of my other debt.

Thank you for reading this far. As I said, anything you can spare, even $5, is greatly appreciated and will extend a long way. Sharing this across your networks is also greatly appreciated and will help more than words can say. Thank you so so so much.

Link to donate to GoFundMe

Verification proof below, as of September 26, 2024.

Verification

Parathyroidectomy

Primary hyperparathyrodism estimated cost of surgery (post-deductible) via United Healthcare

Full report pathology of single adenoma found on left adenoma via initial 4D scan, with additional verification of PTH and calcium levels.

Upcoming appointments set with prospective surgeon and bone density scan

Dental Care

Payments made toward CareCredit via Tend UWS, where I am receiving treatment.

Completed dental care thus far

Link to donate to GoFundMe

[vishnubhagwat]

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